Healthcare Provider Details

I. General information

NPI: 1124954474
Provider Name (Legal Business Name): AARRTHI SANTHANA KRISHNAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W NORTHMOOR RD STE A
PEORIA IL
61614-3425
US

IV. Provider business mailing address

1800 W PEACH BUD DR APT 12309
PEORIA IL
61615-7030
US

V. Phone/Fax

Practice location:
  • Phone: 309-690-3368
  • Fax:
Mailing address:
  • Phone: 567-200-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: