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

Maple Shade Dental Camp Street LLC

Organization Dentist · NPI 1497003156

Maple Shade Dental Camp Street LLC is a Dentist in East Peoria, Illinois. Licensed in Illinois. Registered with an NPI since 2012.

Licensed in
IL
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

809 W Camp St
East Peoria, IL 61611-7218
Phone: (309) 694-0606
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X (IL)

Record details

NPI number1497003156
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Victoria Johnson — Cro · (941) 444-0558
NPI enumeratedAugust 28, 2012
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026
Mailing address809 W Camp St, East Peoria, IL 61611-7218

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