PEDIATRIC DENTAL GROUP II, LLC (NPI# 1912553215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912553215 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTAL GROUP II, LLC |
| Other Organization Name | ADVENTURE DENTAL OF MIDWEST CITY |
| Practice Address |
1200 S Air Depot Blvd Midwest City OK 73110-4866 |
| Mailing Address |
2221 E Bijou St Ste 100 Colorado Springs CO 80909-8009 |
| Practice Telephone | 9188727009 |
| Mailing Telephone | 7195761850 |
| Mailing Fax Number | 7199553470 |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2020-03-30 |
| Authorized Official Name | SHAUN URBANOZO (CREDENTIALING MANAGER) |
| Authorized Official Telephone | 7193232362 |
| Is Organization Subpart | Y |
| Parent Organization Name | PEDIATRIC DENTAL GROUP II, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | OK STATE DENTAL LICENSE | 3942 | 01 |
| Other Name | Type Code |
|---|---|
| Adventure Dental of Midwest City | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760864235 | Pediatric Dental Group II, LLC | Dentist | 7715 E 91st St Ste A, Tulsa, OK 74133-6060 | 2015-06-22 |
| Street Address |
1200 S AIR DEPOT BLVD |
| City | MIDWEST CITY |
| State | OK |
| Zip Code | 73110-4866 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952358616 | John P Theobald | Dentist | 1200 S Air Depot Blvd, I, Midwest City, OK 73110-4848 | 2006-05-28 |
| 1750928412 | Hero Vision of Midwest City Pllc | Optometrist | 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 | 2019-12-02 |
| 1508411968 | Hero Dental of Oklahoma PC | Dentist | 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 | 2019-08-02 |
| 1366924698 | Suneel Makineni | Dentist | 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 | 2018-09-04 |
| 1235656687 | Alia Abdulhadi | Dentist | 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 | 2017-08-26 |
| 1659785343 | Mehwish Nouman Jan | Dentist | 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 | 2014-06-20 |
| 1639494149 | Kool Smiles Ok, PC | Dentist | 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 | 2010-03-29 |
| 1407085269 | Shalini Sanku | Dentist | 1200 S Air Depot Blvd, Midwest City, OK 73110-4866 | 2009-07-14 |
| 1811022593 | Allied Physician's Group Inc PC | Durable Medical Equipment & Medical Supplies | 1200 S Air Depot Blvd, Ste P, Midwest City, OK 73110-4866 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255939377 | Torry E Elston | Technician/Technologist | 5908 Se 15th St, Midwest City, OK 73110 | 2020-10-12 |
| 1083225783 | Daniel B Nguyen | Pharmacist | 1601 S Air Depot, Midwest City, OK 73110 | 2020-08-14 |
| 1114494903 | Tiandrea Jeanae Neal | Behavioral Analyst | 1212 S. Air Depot, Ste 17, Midwest City, OK 73110 | 2018-10-30 |
| 1467902593 | Brian Christopher Lewis | Case Manager/Care Coordinator | 8616 Cedar Ridge Drive, Midwest City, OK 73110 | 2016-10-13 |
| 1669839312 | National Iom, Pllc | Electrodiagnostic Medicine | 1205 S. Air Depot # 102, Midwest City, OK 73110 | 2016-01-26 |
| 1003292210 | Alexandrea Funston | Speech-Language Pathologist | 224 E Blossom Drive, Midwest City, OK 73110 | 2015-08-11 |
| 1184053399 | Ronya Caraway | Community/Behavioral Health | 7901 Ne 10th, B106, Midwest City, OK 73110 | 2013-11-07 |
| 1245678374 | Layfette Lamar Fletcher | Counselor | 405 Delia Street, Midwest City, OK 73110 | 2013-06-11 |
| 1114364163 | Kathryn Ann Gray | Social Worker | 1391 North Midwest Blvd., Midwest City, OK 73110 | 2013-05-31 |
| 1841542545 | Steven Atkins Akinnfest | Counselor | 417 Reed Place, Midwest City, OK 73110 | 2012-10-05 |
| Find all providers in zip 73110 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518578095 | Summer Dental Midwest City, Pllc | Clinic/Center | 1900 S Air Depot Blvd Ste 1, Midwest City, OK 73110-5522 | 2020-08-10 |
| 1477073526 | Lauren A. Huffaker, Dds, Pllc | Clinic/Center | 1200 S Air Depot Blvd Ste I, Midwest City, OK 73110-4848 | 2017-06-20 |
| 1235270083 | Robert W. Utecht, D.d.s., Inc. | Clinic/Center | 1908 S Post Rd, Bldg. #1, Midwest City, OK 73130-6600 | 2007-02-12 |
| 1770138604 | Melanie D. Emerson, Dds PC | Clinic/Center | 9708 E Reno Ave, Midwest City, OK 73130-3502 | 2019-08-07 |
| 1750880399 | Midwest Smiles, Pllc | Clinic/Center | 9321 E Reno Ave, Midwest City, OK 73130-3321 | 2018-02-09 |
| 1801311709 | Leaha D Nels Dds Pllc | Clinic/Center | 101 N Douglas Blvd Ste T, Midwest City, OK 73130-3328 | 2017-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609474758 | Sand Springs Dentistry and Braces | Clinic/Center | 152 W. Alexander Blvd, Ste E, Sand Springs, OK 74063 | 2020-10-12 |
| 1831796580 | Perry Smiles LLC | Clinic/Center | 505 N 14th St Ste B, Perry, OK 73077-5000 | 2020-10-06 |
| 1922626639 | Dental Lodge of Purcell | Clinic/Center | 1929 S Green Ave, Purcell, OK 73080-6203 | 2020-07-09 |
| 1821616533 | Enhance Dental of Norman | Clinic/Center | 1049 12th Ave Ne # 100, Norman, OK 73071-5312 | 2020-07-09 |
| 1164049185 | Custom Dental of Yukon, Pllc | Clinic/Center | 4425 Grant Blvd, Yukon, OK 73099 | 2020-06-26 |
| 1720600174 | Piedmont Dentistry & Braces | Clinic/Center | 12000 Nw Expressway, Yukon, OK 73099 | 2020-05-08 |
| 1073135588 | Yukon Dentistry & Braces | Clinic/Center | 901 E Main Street, Suite 100, Yukon, OK 73099 | 2020-05-07 |
| 1265052062 | Ada Dentistry and Braces | Clinic/Center | 931 Arlington St Ste 3, Ada, OK 74820-4025 | 2020-04-21 |
| 1225657133 | Impressions Dental of Harrah | Clinic/Center | 20926 Se 29th St Ste A, Harrah, OK 73045-6610 | 2020-04-10 |
| 1063041275 | Fleming Dental Co Pllc | Clinic/Center | 13316 S Western Ave Ste B, Oklahoma City, OK 73170-7309 | 2020-04-08 |
| Find all providers with the same taxonomy | ||||
| City | MIDWEST CITY |
| Zip Code | 73110 |
Please comment or provide details below to improve the information on PEDIATRIC DENTAL GROUP II, LLC.
| 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.