Healthcare Provider Details

I. General information

NPI: 1851961676
Provider Name (Legal Business Name): TURNER GRAHAM REID DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W GLEN AVE STE 230
PEORIA IL
61614-4691
US

IV. Provider business mailing address

2015 W GLEN AVE STE 230
PEORIA IL
61614-4691
US

V. Phone/Fax

Practice location:
  • Phone: 309-673-4616
  • Fax:
Mailing address:
  • Phone: 309-673-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: