SMALLTOWN DENTAL GLEN LLC
NPI 1477148179
Dentist - General Practice in Peoria, IL

Q: What is Smalltown Dental Glen LLC's NPI number?

The NPI number for Smalltown Dental Glen LLC is 1477148179. It was assigned to this organization in the NPPES registry on March 4, 2021.

Q: What is Smalltown Dental Glen LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since March 04, 2021

2015 W GLEN AVE STE 230, PEORIA, IL 61614(309) 673-4616 Get Directions Write a Review

NPPES record last updated: March 4, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Smalltown Dental Glen Llc NPPES

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

SMALLTOWN DENTAL GLEN LLC (NPI 1477148179) is a healthcare organization registered as a general practice in Peoria, Illinois and active in the NPI registry since March 2021. The organization lists Luke Overcash, Operations Manager, as its authorized official.

NPPES Registry Identity

NPI1477148179

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameSMALLTOWN DENTAL GLEN LLC

Location Address2015 W GLEN AVE STE 230Peoria, IL 61614-4691

Mailing Address1600 S 4th Ave Ste 110Morton, IL 61550-3401 · (309) 370-5853

Phone(309) 673-4616

Organization SubpartYesParent: Smalltown Dental Management Llc

Authorized OfficialLuke OvercashOperations Manager · (309) 370-5853

Enumeration DateMarch 4, 2021

NPPES CertifiedMarch 4, 2021

✔ NPI 1477148179 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

2015 W GLEN AVE STE 230, Peoria, IL 61614

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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 2

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

SHANNON HAVEL DDS

Dentist (General Practice)

2015 W GLEN AVE STE 230
PEORIA, IL 61614

Peoria County (309) 673-4616

TURNER GRAHAM REID DDS

Dentist

2015 W GLEN AVE STE 230
PEORIA, IL 61614

Peoria County (309) 673-4616

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 Smalltown Dental Glen LLC's NPI number?

The NPI number for Smalltown Dental Glen LLC is 1477148179. It was assigned to this organization in the NPPES registry on March 4, 2021.

Where is Smalltown Dental Glen LLC located?

Smalltown Dental Glen LLC is located at 2015 W Glen Ave Ste 230, Peoria, IL 61614. The listed phone number is (309) 673-4616.

What is Smalltown Dental Glen LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Smalltown Dental Glen LLC was last updated on March 4, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.