Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Maple Shade Dental Bloomington LLC

Organization Dentist · NPI 1366795437

Maple Shade Dental Bloomington LLC is a Dentist in Bloomington, Illinois. Registered with an NPI since 2012.

In the registry since
2012
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

107 S Prospect Rd
Bloomington, IL 61704-4403
Phone: (309) 663-0433
Fax: (309) 662-1372
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X

Record details

NPI number1366795437
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Victoria Johnson — Cro · (941) 444-0558
NPI enumeratedOctober 26, 2012
Last updated in NPPESJuly 22, 2026
Certification dateJuly 22, 2026
Mailing address107 S Prospect Rd, Bloomington, IL 61704-4403

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