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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 CAMP STREET LLC
NPI 1497003156
Dentist in East Peoria, IL

Active since August 28, 2012
809 W CAMP ST, EAST PEORIA, IL 61611(309) 694-0606 Get Directions Write a Review

NPPES record last updated: July 21, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Maple Shade Dental Camp Street Llc NPPES

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

MAPLE SHADE DENTAL CAMP STREET LLC (NPI 1497003156) is a healthcare organization registered as a dentist in East Peoria, Illinois and active in the NPI registry since August 2012. The organization lists Victoria J Johnson, Cro, as its authorized official.

NPPES Registry Identity

NPI1497003156
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameMAPLE SHADE DENTAL CAMP STREET LLC
Location Address809 W CAMP STEast Peoria, IL 61611-7218
Mailing Address809 W Camp StEast Peoria, IL 61611-7218
Phone(309) 694-0606
Organization SubpartNo
Authorized OfficialVictoria J JohnsonCro · (941) 444-0558
Enumeration DateAugust 28, 2012
Last NPPES UpdateJuly 21, 2026
NPPES CertifiedJuly 21, 2026
✔ NPI 1497003156 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.
809 W CAMP ST, East Peoria, IL 61611
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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

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.

DR. MORGAN MARIE SHANAHAN DMD
Dentist
809 W CAMP ST
EAST PEORIA, IL 61611
Tazewell County (309) 694-0606
DR. THOMAS R NALEPKA D.D.S.
Dentist
809 W CAMP ST
EAST PEORIA, IL 61611
Tazewell County (309) 694-0606
THOMAS R. NALEPKA D.D.S
Dentist (General Practice)
809 W CAMP ST
EAST PEORIA, IL 61611
Tazewell County (309) 694-0606

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 Camp Street LLC's NPI number?

The NPI number for Maple Shade Dental Camp Street LLC is 1497003156. It was assigned to this organization in the NPPES registry on August 28, 2012.

Where is Maple Shade Dental Camp Street LLC located?

Maple Shade Dental Camp Street LLC is located at 809 W Camp St, East Peoria, IL 61611. The listed phone number is (309) 694-0606.

What is Maple Shade Dental Camp Street LLC's specialty?

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

What insurance does Maple Shade Dental Camp Street LLC accept?

Health plans from UnitedHealthcare list Maple Shade Dental Camp Street LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Maple Shade Dental Camp Street 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 28 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.