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

Maple Shade Dental (East Peoria) LLC

Organization Dentist · NPI 1245522267

Maple Shade Dental (East Peoria) LLC is a Dentist in East Peoria, Illinois. Registered with an NPI since 2011.

In the registry since
2011
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

1001 Illini Dr
East Peoria, IL 61611-1883
Phone: (309) 694-2620
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X

Record details

NPI number1245522267
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Victoria Johnson — Cro · (941) 444-0558
NPI enumeratedMay 10, 2011
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026
Mailing address6240 Lake Osprey Dr Dept 56057, Lakewood Ranch, FL 34240-8421

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