OrganizationActive
Maple Shade Dental Bloomington LLC
NPI 1366795437 · Dentist · Bloomington, IL
Provider details
- NPI number
- 1366795437
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Mike Cole, Vp Insurance Plan Management(727) 726-1611
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
107 S Prospect Rd
Bloomington, IL 61704-4403
Phone: (309) 663-0433
Fax: (309) 662-1372
Street-level locationGet directions
Mailing address
107 S Prospect Rd
Bloomington, IL 61704-4403
Registry dates
- Enumerated
- 2012-10-26
- Last updated
- 2015-04-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.