PEDIATRIC DENTAL GROUP II, LLC


Address: 7715 E 91st St Ste A, Tulsa, OK 74133-6060
Phone: 9185853744

PEDIATRIC DENTAL GROUP II, LLC (NPI# 1760864235) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1760864235
Entity Type Organization
Organization Name PEDIATRIC DENTAL GROUP II, LLC
Other Organization Name PEDIATRIC DENTAL GROUP II, LLC
Practice Address 7715 E 91st St Ste A
Tulsa
OK 74133-6060
Mailing Address 2221 E Bijou St Ste 100
Colorado Springs
CO 80909-8009
Practice Telephone 9185853744
Mailing Telephone 7195761850
Mailing Fax Number 7199553470
Enumeration Date 2015-06-22
Last Update Date 2020-03-30
Authorized Official Name SHAUN URBANOZO (CREDENTIALING MANAGER)
Authorized Official Telephone 7193232362
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223P0221X Dentist
Specialization: Pediatric Dentistry
32 OK Dental Providers

Other Provider Identifier

State Issuer Identifier Type Code
OK OK DENTAL LICENSE 3942 01

Other Provider/Organization Names

Other Name Type Code
Pediatric Dental Group II, LLC Doing Business As Name - Organization
Pediatric Dental Group, LLC Doing Business As Name - Organization

Provider Secondary Practice Location

Address Telephone Number Fax Number
1200 S Air Depot Blvd, Midwest City, OK 731104866 9185853744 9185853774

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1912553215 Pediatric Dental Group II, LLC Clinic/Center 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 2019-08-13

Office Location

Street Address 7715 E 91ST ST STE A
City TULSA
State OK
Zip Code 74133-6060

Providers in the same location

NPI Name Taxonomy Address Enumeration
1053875690 Hero Dental of Oklahoma PC Dentist 7715 E 91st St Ste A, Tulsa, OK 74133-6060 2019-01-28

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1932725058 Economy Pharmacy Pharmacy 10120 E 91st, Tulsa, OK 74133 2020-06-24
1710539424 Fresenius Medical Care Tulsa, LLC Clinic/Center 9310 East 91st Street, Tulsa, OK 74133 2019-07-12
1003382060 Carefirst Pharmacy Tulsa, Inc. Pharmacy 6214 S. Sheridan Rd, Tulsa, OK 74133 2018-10-17
1003397332 Adekemi Taiwo Nurse Practitioner Hillcrest South Medical Plaza, 8803 S. 101 St E. Ave. Suite 350, Tulsa, OK 74133 2018-08-24
1346732013 Lauren Nichols Dentist 7707 E 111th St Ste 105, Tulsa, OK 74133 2018-05-30
1699264259 Courtney N Johnson, Pllc Dentist 7901 S Sheridan Rd Unit A, Tulsa, OK 74133 2018-05-08
1417464199 Tulsa Medical and Orthopedic Center PC Family Medicine 8165 S Mingo Rd Ste 200, Tulsa, OK 74133 2018-01-04
1013421023 Susan C. Willard, Do, Pllc Family Medicine 6532 E. 71st Street, Suite 150, Tulsa, OK 74133 2017-11-29
1851800825 Seyva LLC Clinic/Center 8522 S 70th E Ave, Tulsa, OK 74133 2017-09-21
1477072031 Amanda Dawn Long Registered Nurse 10507 E 91st St Ste 310, Tulsa, OK 74133 2017-09-14
Find all providers in zip 74133

Taxonomy Information

Taxonomy Code 1223P0221X
Grouping Dental Providers
Classification Dentist
Specialization Pediatric Dentistry

Taxonomy Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Notes: Source: Council on Dental Education and Licensure, American Dental Association

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1548472137 James F. Owens Dds Ms PC Dentist 10507 E 91st Street Suite 410, Tulsa, OK 74133 2007-05-04
1235283524 Thomas Harold Gilbert Sr. Dentist 7116 S Mingo Rd, # 112, Tulsa, OK 74133 2007-01-23
1932269933 Charles R. Keithline Dentist 1421 E 13th St, Tulsa, OK 74120-5207 2006-12-11
1356351662 Mlk Dentistry Inc Dentist 2930 S Pittsburg Ave, Tulsa, OK 74114 2006-08-09
1750326690 Sarah M Fox Dentist 6585 S Yale Ave Ste 510, Tulsa, OK 74136-8384 2006-06-17
1598742751 James George Steyer Jr. Dentist 10127 S Yale Ave, Tulsa, OK 74137-6002 2005-12-29
1881688513 Gary Wallace Fisher Dentist 1203 E 33rd St, Ste 100, Tulsa, OK 74105-2040 2005-09-08
1376542928 Ronald Lynn Winder Dentist 5602 S Memorial Dr, Tulsa, OK 74145-9016 2005-07-17
1992368278 On The Cusp Midtown Pllc Dentist 4444 S Harvard Ave, Tulsa, OK 74135-2634 2019-04-22
1114249190 Fox Broermann Pediatric Dentistry of Tulsa Dentist 6585 S Yale Ave Ste 510, Tulsa, OK 74136-8384 2010-02-18
Find all providers in TULSA

Competitor

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City TULSA
Zip Code 74133

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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