Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1093400160 Individual Practitioner Male Practitioner

Jonathan Phen

Dentist • East Peoria, IL

Professional Overview & Biography Verified Profile Summary

Jonathan Phen is a registered healthcare professional specializing in Dentist in East Peoria, IL. Practice services are available at 502 RIVERSIDE DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

502 Riverside Dr

East Peoria, IL 616112068

Telephone 3096065008
Associated Practice Facility / Clinic
🏢 Secure Dental V Facility NPI 1629506043

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in East Peoria, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 45.0 Yrs
State Avg: 12.1 Yrs
Regional Practice Density
13 Specialists

Practicing in East Peoria, IL (4751 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-04-10
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License IL 019034133

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1083339626

Doctor of Dental Surgery

NPI 1942926068

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 10, 2023

Dentist (License #019034133 in IL)

NPI Profile Active April 05, 2023

NPI status registered as active in NPPES database

📍
Updated Practice Location April 05, 2023

Registered at 502 RIVERSIDE DR, EAST PEORIA, IL 616112068 (Tel: 3096065008)

📍
Updated Business Mailing Address April 05, 2023

Registered at 2121 45TH ST APT 2322, HIGHLAND, IN 463220006 (Tel: 9549974175)

👤
Provider Name / Credentials Updated April 05, 2023

Recorded as JONATHAN PHEN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 05, 2023

Dentist (License #019034133 in IL)

🟢
Initial NPI Registration & Enumeration April 05, 2023

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093400160
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 05, 2023
Last Update: April 10, 2023
Sole Proprietor: Yes

Mailing Address

2121 45th St Apt 2322

Highland, IN 463220006

Phone: 9549974175

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.