DR. JOHN TERRANCE PETERSON DDS NPI 1720035702

NPI Information

  • NPI: 1720035702
  • Provider Name: DR. JOHN TERRANCE PETERSON, DDS
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • Address: 200 EAST COURT STREET
    SUITE 504
    KANKAKEE, IL
    ZIP 60901
  • Phone: (815) 932-3613

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NPI Details

DR. John Terrance Peterson, DDS is a general practice dentist in Kankakee, IL. The provider is 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. DR. John Terrance Peterson, DDS NPI is 1720035702. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

200 EAST COURT STREET
SUITE 504
KANKAKEE, IL
ZIP 60901-847
Phone: (815) 932-3613
Fax: (815) 932-5332

The enumeration date for this NPI number is 5/27/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice19A14762ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1021076OTHERILLINOISFIRST COMMONWEALTH
2606970OTHERILLINOISUNITED CONCORDIA
31003311MEDICARE ID-TYPE UNSPECIFIEDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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