Pediatric Dental Group, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

784 Issued in OK

Legal business name

PEDIATRIC DENTAL GROUP, LLC

Practice address

1421 E 13TH St
Tulsa, OK 74120-5207

Phone

(918) 585-3744

Fax

(918) 585-3774

NPI assigned

Mar 24, 2009

Last updated

Mar 24, 2009By 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

Dr. Charles R Keithline III, DDSNPI 1932269933

Title

Managing Member

Phone

(918) 585-3744

Specialties & licenses 1

Addresses

Locations

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.

• Charles R. Keithline, DDS

  • Pediatric Dentistry
  • Tulsa, OK
  • NPI 1932269933
  Authorized official Same address or phone

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1609018548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 E 13TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741205207",
            "telephone_number": "918-585-3744",
            "fax_number": "918-585-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 E 13TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741205207",
            "telephone_number": "918-585-3744",
            "fax_number": "918-585-3774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-24",
        "last_updated": "2009-03-24",
        "status": "A",
        "authorized_official_last_name": "KEITHLINE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "918-585-3744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OK",
            "license": "784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Pederson
• Vanessa Pederson, B.A.D.O, B.S.O.
• Pediatric and Adolescent Care, LLP
• Pediatric Cardiology of Oklahoma P.L.L.C.
• Pediatric Dental Group II, LLC
• Pediatric Dentistry of Tulsa P.C.
• Pediatric Occupational Therapy, LLC
• Pediatric Ophthalmology, PC (Pediatric and Family Eyeware)
• Pediatric Ophthalmology, PC (Pediatric Eye Associates, Gary T. Denslow & Kids Point of View)
• Pediatric Respiratory Sleep Services

• Pediatric Dentistry in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Pediatric Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; 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.