Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1144352170 Individual Practitioner Male Practitioner

Dr. Robert M. Wynn , DMD

Dentist - General Practice • Peoria, IL

Professional Overview & Biography Verified Profile Summary

Dr. Robert Wynn, DMD is a registered healthcare professional specializing in Dentist - General Practice in Peoria, IL. Practice services are available at 4517 N ROCKWOOD DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4517 N Rockwood Dr

Peoria, IL 616153841

Telephone 3096881021
Fax 3096885643
Associated Practice Facility / Clinic
🏢 Peoria Dental Care Facility NPI 1851909345

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Peoria, IL

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

Practicing in Peoria, 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

CMS Verified: 2020-12-10
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IL 019021592

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.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License IL 019-021592

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.

Practice Associates & Co-Workers

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

3 Associated Practitioners
NPI 1538613880

Doctor of Dental Medicine

Dr. Matthew Liesen , DMD

Dentist - General Practice

NPI 1619350725

Doctor of Dental Medicine

Dr. Micah Roberts , DMD

Dentist - General Practice

NPI 1760746747

Doctor of Dental Medicine

Career & Practice History Timeline

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

10 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 10, 2020

Dentist (License #019021592 in IL)

📍
Updated Practice Location October 06, 2020

Registered at 4517 N ROCKWOOD DR, PEORIA, IL 616153841 (Tel: 3096881021)

📍
Updated Business Mailing Address October 06, 2020

Registered at 4517 N ROCKWOOD DR, PEORIA, IL 616153841 (Tel: 3096881021)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 06, 2020

Dentist (License #019-021592 in IL)

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 4516 N STERLING AVE, SUITE 400, PEORIA, IL 616153827 (Tel: 3096881021)

📍
Updated Business Mailing Address July 08, 2007

Registered at 4516 N STERLING AVE, SUITE 400, PEORIA, IL 616153827 (Tel: 3096881021)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as ROBERT WYNN, DMD

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

Dentist

🟢
Initial NPI Registration & Enumeration March 13, 2007

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: 1144352170
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 13, 2007
Last Update: December 10, 2020
Sole Proprietor: Yes

Mailing Address

4517 N Rockwood Dr

Peoria, IL 616153841

Phone: 3096881021

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.