Pediatric Dental Group of Wheat Ridge

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

7843 Issued in CO

Legal business name

PEDIATRIC DENTAL GROUP OF WHEAT RIDGE

Practice address

3555 Lutheran Pkwy
Suite 310
Wheat Ridge, CO 80033-6021

Phone

(303) 467-8888

NPI assigned

May 22, 2017

Last updated

May 22, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

PEDIATRIC DENTAL GROUP OF COLORADOAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristen Barden

Title

Practice Manager

Phone

(303) 421-5437

Specialties & licenses 6

Addresses

Other identifiers 6

Part of

Pediatric Dental Group Managment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495411200000",
    "number": "1043747900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 LUTHERAN PKWY",
            "address_2": "SUITE 310",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 LUTHERAN PKWY",
            "address_2": "SUITE 310",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336021",
            "telephone_number": "303-467-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL GROUP OF WHEAT RIDGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC DENTAL GROUP OF COLORADO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2017-05-22",
        "status": "A",
        "authorized_official_last_name": "BARDEN",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "303-421-5437"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "7843",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "8332",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "651",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "10389",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CO",
            "license": "104994",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CO",
            "license": "104928",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38371847",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02078434",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81227078",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56483546",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02006518",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64351084",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Payne, PHARMD
• Peak Form LLC
• Peak Pediatrics PLLC (Peak Pediatrics)
• Kelly J Pearson, PA
• Timbree May Pederson, LCSW
• Pediatrics West, P.C.
• Robert Carl Pekrul III
• Starlene S Peluso
• Jacqueline Pena-Sosa
• Gabriela Pena

• Pediatric Dentistry in Wheat Ridge, CO
• Providers in Wheat Ridge, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.