Pediatric Dentistry, P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

6566 Issued in NE

Legal business name

PEDIATRIC DENTISTRY, P.C.

Practice address

3901 Pine Lake Rd Ste 250
Lincoln, NE 68516-5497

Phone

(402) 423-3322

NPI assigned

Nov 5, 2013

Reactivated

Dec 12, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Brent D Johnson, DDSNPI 1790708857

Title

Pediatric Dentist

Phone

(402) 423-3322

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent David Johnson, D.D.S.

  • Pediatric Dentistry
  • Lincoln, NE
  • NPI 1790708857
  NPD (past) Authorized official

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1154750677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 PINE LAKE RD STE 250",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685165497",
            "telephone_number": "402-423-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 PINE LAKE RD STE 250",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685165497",
            "telephone_number": "402-423-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-05",
        "last_updated": "2018-12-12",
        "deactivation_date": "2013-11-08",
        "reactivation_date": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "402-423-3322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NE",
            "license": "6566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025649100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Ann Pedersen
• Richard Pedersen
• Pediatric and Medical Genetics Services PC
• Pediatric Dental Arts, P.C.
• Pediatric Dental Specialists of Greater Nebraska - Lincoln LLC
• Pediatrics, P.C.
• Shannon Peek
• Macy Elizabeth Pegram
• Jared Pehrson, M.D.
• Kenneth Wayne Peirce

• Dental Clinic/Center in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Dental Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; 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.