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 provides Dentist services 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
Show map & directions

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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