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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 BLOOMINGTON LLC
NPI 1366795437
Dentist in Bloomington, IL

Active since October 26, 2012
107 S PROSPECT RD, BLOOMINGTON, IL 61704(309) 663-0433(309) 662-1372 Get Directions Write a Review

NPPES record last updated: July 22, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Maple Shade Dental Bloomington Llc NPPES

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

MAPLE SHADE DENTAL BLOOMINGTON LLC (NPI 1366795437) is a healthcare organization registered as a dentist in Bloomington, Illinois and active in the NPI registry since October 2012. The organization lists Victoria Johnson, Cro, as its authorized official.

NPPES Registry Identity

NPI1366795437
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameMAPLE SHADE DENTAL BLOOMINGTON LLC
Location Address107 S PROSPECT RDBloomington, IL 61704-4403
Mailing Address107 S Prospect RdBloomington, IL 61704-4403
Phone(309) 663-0433
Fax(309) 662-1372
Organization SubpartNo
Authorized OfficialVictoria JohnsonCro · (941) 444-0558
Enumeration DateOctober 26, 2012
Last NPPES UpdateJuly 22, 2026
NPPES CertifiedJuly 22, 2026
✔ NPI 1366795437 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.
107 S PROSPECT RD, Bloomington, IL 61704
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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.

BROCK GARDNER
Dentist (Dental Public Health)
107 S PROSPECT RD
BLOOMINGTON, IL 61704
McLean County (309) 808-6263
DR. CLINT BOYLE DMD
Dentist
107 S PROSPECT RD
BLOOMINGTON, IL 61704
McLean County (309) 663-0433
DR. ROBERT OWEN WOLF DDS
Dentist
107 S PROSPECT RD
BLOOMINGTON, IL 61704
McLean County (309) 663-0433

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 Bloomington LLC's NPI number?

The NPI number for Maple Shade Dental Bloomington LLC is 1366795437. It was assigned to this organization in the NPPES registry on October 26, 2012.

Where is Maple Shade Dental Bloomington LLC located?

Maple Shade Dental Bloomington LLC is located at 107 S Prospect Rd, Bloomington, IL 61704. The listed phone number is (309) 663-0433.

What is Maple Shade Dental Bloomington 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 Bloomington LLC was last updated on July 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.