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

Jonathan Phen

Individual provider Dentist · NPI 1093400160

Jonathan Phen is a Dentist in East Peoria, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2023
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Practice location Address checks out

502 Riverside Dr
East Peoria, IL 61611-2068
Phone: (309) 606-5008
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 019034133 (IL)

Record details

NPI number1093400160
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 5, 2023
Last updated in NPPESApril 10, 2023
Certification dateApril 10, 2023
Mailing address2121 45th St Apt 2322, Highland, IN 46322-0006

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