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Maple Shade Dental Bloomington LLC

Dentist in Bloomington, IL · enumerated 2012 · authorized official Victoria Johnson, Cro.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1366795437

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Registry record

Entity type Organization (Type 2)
Legal business name Maple Shade Dental Bloomington LLC
Practice address 107 S Prospect Rd, Bloomington, IL, 61704
Phone (309) 663-0433
Fax (309) 662-1372
Enumeration date Oct 26, 2012
Last updated in NPPES Jul 22, 2026

Taxonomy & classification

122300000X Dentist Dental Providers Primary

Authorized official

Name Victoria Johnson
Title Cro
Phone (941) 444-0558

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2026-07-22. Verify at npiregistry.cms.hhs.gov.
Where is Maple Shade Dental Bloomington LLC located?
The practice location on file with NPPES is in Bloomington, IL.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2026-07-22.