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DR. KELISSA L PETERSON DMD
NPI 1861047284
Dentist - General Practice in Streator, IL

Active since August 02, 2019
318 N BLOOMINGTON ST, STREATOR, IL 61364(815) 672-2647(815) 672-5201 Get Directions Write a Review

NPPES record last updated: August 2, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Kelissa L Peterson Dmd NPPES

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

DR. KELISSA L PETERSON DMD (NPI 1861047284) is an individual general practice provider in Streator, Illinois, licensed in Illinois (019032290) and active in the NPI registry since August 2019.

NPPES Registry Identity

NPI1861047284
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. KELISSA L PETERSONCredential: DMD
Location Address318 N BLOOMINGTON STStreator, IL 61364-2218
Mailing Address2632 N 3739th RdSheridan, IL 60551-9474 · (815) 207-9735
Phone(815) 672-2647
Fax(815) 672-5201
Sole ProprietorNo
Enumeration DateAugust 2, 2019
✔ NPI 1861047284 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in IL · 019032290
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.
318 N BLOOMINGTON ST, Streator, IL 61364
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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. JAMES JEROME BEAGLE DDS
Dentist
318 N BLOOMINGTON ST
STREATOR, IL 61364
Lasalle County (815) 672-3360
DR. MARIE LOUISE ONESTO DDS
Dentist
318 N BLOOMINGTON ST
STREATOR, IL 61364
Lasalle County (815) 672-2647
DR. BRENDAN DAVID GRAHAM D.M.D
Dentist (General Practice)
318 N BLOOMINGTON ST
STREATOR, IL 61364
Lasalle County (815) 672-2647

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 Kelissa Peterson's NPI number?

The NPI number for Kelissa Peterson is 1861047284. It was assigned to this individual provider in the NPPES registry on August 2, 2019.

Where is Kelissa Peterson located?

Kelissa Peterson practices at 318 N Bloomington St, Streator, IL 61364. The listed phone number is (815) 672-2647.

What is Kelissa Peterson'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 Kelissa Peterson was last updated on August 2, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.