Pediatric Dentistry East, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

4655 Issued in AL

Legal business name

PEDIATRIC DENTISTRY EAST, LLC

Practice address

123 N Chalkville Rd
Trussville, AL 35173-1376

Phone

(205) 655-1000

Fax

(205) 228-8044

NPI assigned

Sep 4, 2007

Last updated

Sep 4, 2007By 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

Mrs. Sue Nimer Young, D.M.D

Title

Dentist

Phone

(205) 655-1000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1326232364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 N CHALKVILLE RD",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351731376",
            "telephone_number": "205-655-1000",
            "fax_number": "205-228-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 N CHALKVILLE RD",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351731376",
            "telephone_number": "205-655-1000",
            "fax_number": "205-228-8044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY EAST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "NIMER",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "205-655-1000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AL",
            "license": "4655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lucy Otwell, LICSW
• Katelyn Skipper Owens
• Masum Patel
• Pda of Trussville
• Pda Orthodontics Trussville PLLC (Trussville Pediatric Dentistry)
• Sarah Robertson Pendleton, MSW, LCSW
• Kristin Swindle Penuel, ALC
• Deena Lynn Phillips, RPH
• Howard Phillips, PHARMD
• Samuel D Pierce, O.D.

• Pediatric Dentistry in Trussville, AL
• Providers in Trussville, AL by specialty
• Pediatric Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; 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.