OrganizationActiveAccepts Medicare
Central Illinois Center for Tmj and Facial Pain PC
NPI 1962745232 · Dentist · East Peoria, IL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1962745232
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Jack Walz, Ceo/Director(309) 699-1300
- License
- 060008862 (IL)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(78/100 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
731 Sabrina Dr
Suite a
East Peoria, IL 61611-3581
Phone: (309) 699-1300
Street-level locationGet directions
Mailing address
731 Sabrina Dr
East Peoria, IL 61611-3581
Other names (DBA / former)
- Doing business as
- Tmj & Sleep Apnea Center of Central Il
Registry dates
- Enumerated
- 2013-04-04
- Last updated
- 2013-04-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.