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Active NPI 1720035702 Individual Practitioner Male Practitioner

Dr. John Terrance Peterson , DDS

Dentist - General Practice • Kankakee, IL

Professional Overview & Biography Verified Profile Summary

Dr. John Peterson, DDS is a registered healthcare professional specializing in Dentist - General Practice in Kankakee, IL. Practice services are available at 200 EAST COURT STREET under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

200 East Court Street
Suite 504

Kankakee, IL 609013847

Telephone 8159323613
Fax 8159325332
Associated Practice Facility / Clinic
🏢 John T Peterson Dds Pc Facility NPI 1437436664

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Kankakee, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
5 Specialists

Practicing in Kankakee, IL (5581 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

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IL 19A14762

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID First Commonwealth
021076 (IL)
Commercial Insurance / Payer ID United Concordia
606970 (IL)

Practice Associates & Co-Workers

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

1 Associated Practitioners
Emily Clyden , MHS, CCC-SLP, L

Speech-Language Pathologist

NPI 1194260794

MHS, Speech-Language Pathologist (Certificate of Clinical Competence), L

Career & Practice History Timeline

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

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 200 EAST COURT STREET, SUITE 504, KANKAKEE, IL 609013847 (Tel: 8159323613)

📍
Updated Business Mailing Address July 08, 2007

Registered at 200 EAST COURT STREET, SUITE 504, KANKAKEE, IL 609013847 (Tel: 8159323613)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as JOHN PETERSON, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #19A14762 in IL)

🟢
Initial NPI Registration & Enumeration May 27, 2006

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: 1720035702
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 27, 2006
Last Update: July 13, 2026
Sole Proprietor: No

Mailing Address

200 East Court Street, Suite 504

Kankakee, IL 609013847

Phone: 8159323613

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.