NPIMap

Organization Active NPI

Pawel R Bielecki, DDS, PC

Doing business as Young at Heart Dentistry

  • General Practice Dentistry
  • Pueblo, CO
National Provider Identifier
1467627281
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8809 Issued in CO
Legal business name
PAWEL R BIELECKI, DDS, PC
Doing business as
Young at Heart Dentistry
Practice address
2603 Vinewood LN
Pueblo, CO 81005-3370
Phone
(719) 564-6464
Fax
(719) 564-1888
NPI assigned
Apr 23, 2008
Last updated
Oct 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Michael R Herrera
Title
Business Manager
Phone
(719) 696-9009

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 9492 CO
General Practice Dentistry 1223G0001X 8809 CO Primary

Addresses

Primary practice location

2603 Vinewood LN
Pueblo, CO 81005-3370

Mailing address

2603 Vinewood LN
Pueblo, CO 81005-3370
Phone (719) 564-6464

Other identifiers 1

IdentifierTypeStateIssuer
83505318MedicaidCO

Other names 1

  • Young at Heart Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pawel R Bielecki DDS PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1467627281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 VINEWOOD LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053370",
            "telephone_number": "719-564-6464",
            "fax_number": "719-564-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 VINEWOOD LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053370",
            "telephone_number": "719-564-6464",
            "fax_number": "719-564-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAWEL R BIELECKI, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "719-696-9009"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "9492",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "83505318",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young at Heart Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Young at Heart Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.