Organization
MAPLE SHADE DENTAL BLOOMINGTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA JOHNSON (CRO)
(941) 444-0558
Entity
Organization
Contact information
Practice address
107 S PROSPECT RD, BLOOMINGTON, IL 61704-4403
(309) 663-0433
(309) 662-1372
Mailing address
107 S PROSPECT RD, BLOOMINGTON, IL 61704-4403
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/26/2012
Last updated
07/22/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up