Pedaitric Dental Associates

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDAITRIC DENTAL ASSOCIATES

Practice address

7250 S Durango Dr
Las Vegas, NV 89113-2241

Phone

(702) 270-3047

Fax

(702) 614-0548

NPI assigned

Jul 30, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Timothy A Wilson, D.D.S

Title

Owner

Phone

(702) 270-3047

Specialties & licenses 1

Addresses

Other names 1

• Star Smile Children Dentistry Doing business as

Locations

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

{
    "created_epoch": "1217376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1114183118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7250 S DURANGO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132241",
            "telephone_number": "702-270-3047",
            "fax_number": "702-614-0548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 S DURANGO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132241",
            "telephone_number": "702-270-3047",
            "fax_number": "702-614-0548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDAITRIC DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-30",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-270-3047",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Star Smile Children Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victoria Kylee Peckham Smith
• Samantha Sophia Peckham, APRN FNP-BC PMHNP-BC
• Pecos Medical Group
• Pecos Surgery Center LLC
• Froilan Pecson
• Suneal Gopal Peddada, DO
• Abbigail Peddieson, MFT-LICENSED INTERN
• Kendal L Pedersen
• Robert Pedersen
• Stephen Pedersen, HIGH SCHOOL DIPLOMA

• Pediatric Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Pediatric Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; 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.