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Oral & Maxillofacial Surgeons Of Central Illinois

Dentist · Peoria, IL

Call (309) 693-1200 Directions

At a glance

5009 A Executive Dr, Peoria, IL 61614-4866

NPPES record updated Sep 11, 2025. Public records can lag behind changes at a practice.

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Practice location

5009 A Executive Dr
Peoria, IL 61614-4866
Professional details: NPI, taxonomy & registry record
NPI1275663338
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Registry details

Primary taxonomy
Dentist
Taxonomy code
122300000X
Enumeration date
Mar 7, 2007
Record updated
Sep 11, 2025
More registry details
Provider type
Organization · Type 2
Other reported name
<UNAVAIL>

Reported taxonomies and licenses

Dentist

122300000X · Primary

Specialty details in registry

1223S0112X

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

5009 A Executive Dr
Peoria, IL 61614-4866
Phone
(309) 693-1200
Fax
(309) 693-9998
Mailing address
5009 A EXECUTIVE DRIVE

PEORIA, IL 616144866
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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