Active NPI
Shadow Creek Pediatric Dentistry of Waukee LLC
- Pediatric Dentistry
- Waukee, IA
National Provider Identifier
1417867946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- Legal business name
- SHADOW CREEK PEDIATRIC DENTISTRY OF WAUKEE LLC
- Practice address
- 822 NE Alices Rd
Waukee, IA 50263-8857 - Phone
- (515) 264-2772
- NPI assigned
- Sep 8, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Lucas Bland
- Title
- Coo
- Phone
- (515) 577-6367
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | Primary |
Addresses
Primary practice location
822 NE Alices Rd
Waukee, IA 50263-8857
Mailing address
822 NE Alices Rd
Waukee, IA 50263-8857
Phone (515) 264-2772
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788825600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788825600000",
"number": "1417867946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "822 NE ALICES RD",
"city": "WAUKEE",
"state": "IA",
"postal_code": "502638857",
"telephone_number": "515-264-2772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "822 NE ALICES RD",
"city": "WAUKEE",
"state": "IA",
"postal_code": "502638857",
"telephone_number": "515-264-2772"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHADOW CREEK PEDIATRIC DENTISTRY OF WAUKEE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-08",
"last_updated": "2026-09-08",
"certification_date": "2026-09-08",
"status": "A",
"authorized_official_last_name": "BLAND",
"authorized_official_first_name": "LUCAS",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "515-577-6367",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukee, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.