NPIMap

Organization Active NPI

Pediatric Dental Specialists of Greater Nebraska, P.C.

  • Pediatric Dentistry
  • Hastings, NE
National Provider Identifier
1467553362
Registry record updated Jan 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PEDIATRIC DENTAL SPECIALISTS OF GREATER NEBRASKA, P.C.
Practice address
601 N St Joseph Ave
Hastings, NE 68902-0667
Phone
(402) 462-6557
Fax
(402) 461-4479
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

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

Authorized official

Name
Dave F Johnson
Title
Practice Administrator
Phone
(402) 462-6557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

601 N St Joseph Ave
Hastings, NE 68902-0667

Mailing address

PO Box 667
Hastings, NE 68902-0667
Phone (402) 462-6557

Other practice location 1

425 N Diers Ave Ste 3
Grand Island, NE 68803-4910
Phone (308) 381-4452

Other identifiers 1

IdentifierTypeStateIssuer
10025036700MedicaidNE

National Provider Directory

National Provider Directory

Locations

425 N Diers Ave
#3
Grand Island, NE 68803
Phone (308) 381-4452

601 N Saint Joseph Ave
Hastings, NE 68901
Phone (402) 462-6557

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1467553362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 667",
            "city": "HASTINGS",
            "state": "NE",
            "postal_code": "689020667",
            "telephone_number": "402-462-6557",
            "fax_number": "402-461-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N ST JOSEPH AVE",
            "city": "HASTINGS",
            "state": "NE",
            "postal_code": "689020667",
            "telephone_number": "402-462-6557",
            "fax_number": "402-461-4479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 N Diers Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "Grand Island",
            "state": "NE",
            "postal_code": "688034910",
            "country_code": "US",
            "telephone_number": "308-381-4452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL SPECIALISTS OF GREATER NEBRASKA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "402-462-6557"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025036700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hastings, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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.