Knickerbocker Pediatric Dentistry LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30-023424 Issued in OH

Legal business name

KNICKERBOCKER PEDIATRIC DENTISTRY LLC

Practice address

1 Childrens PLZ
Dayton, OH 45404-1873

Phone

(937) 619-9828

NPI assigned

Jan 26, 2016

Last updated

Jan 26, 2016By 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

Betty Huang, DDS

Title

President

Phone

(419) 463-0023

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453766400000",
    "number": "1447617006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 752144",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454752144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041873",
            "telephone_number": "937-619-9828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNICKERBOCKER PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-26",
        "last_updated": "2016-01-26",
        "status": "A",
        "authorized_official_last_name": "HUANG",
        "authorized_official_first_name": "BETTY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-463-0023",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30-023424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0054438",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aliesha Knauer
• KND Development 59 LLC
• Sarah Nicole Knebel, PT, DPT
• Elizabeth Knecht, MD
• Heidi Elizabeth Knellinger, P.T.
• Juahara Kniess, LPN
• Brittany Knight
• Gregory Knight
• Latriece Knight
• Malinda May Knight

• Pediatric Dentistry in Dayton, OH
• Providers in Dayton, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; 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.