Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MAPLE SHADE DENTAL (EAST PEORIA) LLC
NPI 1245522267
Dentist in East Peoria, IL

Active since May 10, 2011
1001 ILLINI DR, EAST PEORIA, IL 61611(309) 694-2620 Get Directions Write a Review

NPPES record last updated: July 21, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Maple Shade Dental (east Peoria) Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAPLE SHADE DENTAL (EAST PEORIA) LLC (NPI 1245522267) is a healthcare organization registered as a dentist in East Peoria, Illinois and active in the NPI registry since May 2011. The organization lists Victoria J Johnson, Cro, as its authorized official.

NPPES Registry Identity

NPI1245522267
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameMAPLE SHADE DENTAL (EAST PEORIA) LLC
Location Address1001 ILLINI DREast Peoria, IL 61611-1883
Mailing Address6240 Lake Osprey Dr Dept 56057Lakewood Ranch, FL 34240-8421
Organization SubpartNo
Authorized OfficialVictoria J JohnsonCro · (941) 444-0558
Enumeration DateMay 10, 2011
Last NPPES UpdateJuly 21, 2026
NPPES CertifiedJuly 21, 2026
NPI 1245522267 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
1001 ILLINI DR, East Peoria, IL 61611

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dentist (General Practice)
1001 ILLINI DR
EAST PEORIA, IL 61611
Dentist
1001 ILLINI DR
EAST PEORIA, IL 61611
Dentist (General Practice)
1001 ILLINI DR
EAST PEORIA, IL 61611

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maple Shade Dental (east Peoria) LLC's NPI number?

The NPI number for Maple Shade Dental (east Peoria) LLC is 1245522267. It was assigned to this organization in the NPPES registry on May 10, 2011.

Where is Maple Shade Dental (east Peoria) LLC located?

Maple Shade Dental (east Peoria) LLC is located at 1001 Illini Dr, East Peoria, IL 61611. The listed phone number is (309) 694-2620.

What is Maple Shade Dental (east Peoria) LLC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Maple Shade Dental (east Peoria) LLC was last updated on July 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 35 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.