PEDIATRIC DENTAL GROUP II LLC NPI 1912553215

NPI Information

NPI: 1912553215
Provider Name: PEDIATRIC DENTAL GROUP II, LLC

Doing Business As: ADVENTURE DENTAL OF MIDWEST CITY

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
1200 S AIR DEPOT BLVD
MIDWEST CITY, OK
ZIP 73110
Phone: (918) 872-7009
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PEDIATRIC DENTAL GROUP II, LLC is a dental clinic center in Midwest City, OK. PEDIATRIC DENTAL GROUP II, LLC NPI is 1912553215. The provider is registered as an organization entity type.
The provider Is Doing Business As Adventure Dental Of Midwest City.

The provider's business location address is:

1200 S AIR DEPOT BLVD
MIDWEST CITY, OK
ZIP 73110-866
Phone: (918) 872-7009

The provider's authorized official is Shaun Urbanozo .
The authorized official title is Credentialing Manager and has the following contact phone number (719) 323-2362.

The enumeration date for this NPI number is 8/13/2019 and was last updated on 3/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3942	OTHER	OKLAHOMA	OK STATE DENTAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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