NPIMap

Organization Active NPI

Sandia Pediatric Dentistry

  • Pediatric Dentistry
  • Albuquerque, NM
National Provider Identifier
1497008312
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DD3647 Issued in NM
Legal business name
SANDIA PEDIATRIC DENTISTRY
Practice address
7007 Wyoming Blvd NE Ste C-2
Albuquerque, NM 87109-3987
Phone
(505) 200-3516
NPI assigned
Oct 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

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

Authorized official

Name
Dr. Danen Scott Sjostrom, DDS, PH.DNPI 1427379130
Title
Pediatric Dentist
Phone
(614) 949-9685

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DD3647 NM Primary

Addresses

Primary practice location

7007 Wyoming Blvd NE Ste C-2
Albuquerque, NM 87109-3987

Mailing address

7007 Wyoming Blvd NE Ste C-2
Albuquerque, NM 87109-3987
Phone (505) 200-3516

National Provider Directory

National Provider Directory

Locations

7007 Wyoming Blvd NE
Ste C2
Albuquerque, NM 87109
Phone (505) 200-3516

Practitioners & affiliated clinicians

Practitioners 1

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": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1497008312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7007 WYOMING BLVD NE STE C-2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093987",
            "telephone_number": "505-200-3516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7007 WYOMING BLVD NE STE C-2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093987",
            "telephone_number": "505-200-3516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDIA PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "SJOSTROM",
        "authorized_official_first_name": "DANEN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "614-949-9685",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, PH.D"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NM",
            "license": "DD3647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; 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.