Professional Dental Alliance of CT - Pedo, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF CT - PEDO, PLLC

Doing business as

Kids First Pediatric Dentistry & Orthodontics

Practice address

1478 Post Rd
Fairfield, CT 06824-5938

Phone

(203) 307-1550

Fax

(203) 255-7782

NPI assigned

Nov 18, 2024

Last updated

Nov 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Erica Quinteros

Title

Credentialing

Phone

(724) 901-1964

Specialties & licenses 2

Addresses

Other names 1

• Kids First Pediatric Dentistry & Orthodontics Doing business as

Tax ID family

Kids First Pediatric Dentistry Orthodontics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Dental Alliance of CT - Pedo, PLLC

  dba Kids First Pediatric Dentistry & Orthodontics

  • Oral and Maxillofacial Surgery (Dentist)
  • Fairfield, CT
  • NPI 1942088786
  NPD tax ID

Locations

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1184449977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 ENTERPRISE DR",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152751223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1478 POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245938",
            "telephone_number": "203-307-1550",
            "fax_number": "203-255-7782"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "324 Elm St Ste 101B",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "CT",
            "postal_code": "064682283",
            "country_code": "US",
            "telephone_number": "203-292-9595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "493 Westport Ave",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068514411",
            "country_code": "US",
            "telephone_number": "203-255-6851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF CT - PEDO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "QUINTEROS",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "724-901-1964"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids First Pediatric Dentistry & Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Primed, LLC
• Baylie Pritchard, ND
• William Vanderveer Probasco, M.D., M.S.
• Professional Dental Alliance of CT - Ortho, PLLC (First Impressions Orthodontics)
• Professional Dental Alliance of CT - Ortho, PLLC (First Impressions Orthodontics)
• Professional Dental Alliance of CT - Pedo, PLLC (Kids First Pediatric Dentistry & Orthodontics)
• Roseanne Prunty, PT, DPT
• Eleni Psathas, ATC
• Ptsma, Inc. (Select Physical Therapy)
• Isabella Pugliese, LCSW

• Pediatric Dentistry in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Pediatric Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.