MEDICARE: SMALLTOWN DENTAL RIVER CITY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1881543171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMALLTOWN DENTAL RIVER CITY PLLC

Provider Business Mailing Address
First Line	:	1600 S 4TH AVE STE 110
Second Line	:
City	:	MORTON
State	:	IL
Zip	:	61550-3401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W LAKE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-6020
Country	:	US
Telephone Number	:	309-682-0770
Fax Number	:

Authorized Official
Title or Position	:	CIO
Name	:	LUKE OVERCASH
Credential	:
Telephone Number	:	309-370-5853

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

Similar Medicare Providers

1316019433 — DR. SCOTT WILLIAM ANDERSON DDS
Practice Location Address:

521 W LAKE AVE
PEORIA, IL
61614-6020

Practice Phone: 309-682-0770
Practice Fax: 309-682-7259

1497829063 — DR. ROGER LOUIS PAUL DMD
Practice Location Address:

521 W LAKE AVE
PEORIA, IL
61614-6020

Practice Phone: 309-682-0770
Practice Fax: 309-682-7285

1154728228 — DR. PAUL & DR. ANDERSON, DENTAL PC
Practice Location Address:

521 W LAKE AVE
PEORIA, IL
61614-6020

Practice Phone: 309-682-0770
Practice Fax:

1689569667 — KISHAN PATEL DPM
Practice Location Address:

3322 W WILLOW KNOLLS DR
PEORIA, IL
61614-8148

Practice Phone: 309-691-5800
Practice Fax:

1528937240 — RYAN MONUAI VINING-CALDWELL
Practice Location Address:

6516 N UNIVERSITY ST APT 1122
PEORIA, IL
61614-2752

Practice Phone: 773-984-4207
Practice Fax:

1447866900 — CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Practice Location Address:

2112 E WAR MEMORIAL DR
PEORIA, IL
61614-8002

Practice Phone: 309-431-5880
Practice Fax:

Directions to “SMALLTOWN DENTAL RIVER CITY PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.