Pediatric and Adolescent Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PEDIATRIC AND ADOLESCENT DENTISTRY

Practice address

9 Chenoweth Dr
Bridgeport, WV 26330-1885

Phone

(304) 842-1921

Fax

(304) 842-1960

NPI assigned

Feb 27, 2024

Last updated

Feb 27, 2024By 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. Moe Momen, DDS

Title

Owner

Phone

(304) 842-1921

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.

• Seyed Moe Momen, DDS

  • Pediatric Dentistry
  • Bridgeport, WV
  • NPI 1306912258
  NPD

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

{
    "created_epoch": "1708992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1669238572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CHENOWETH DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301885",
            "telephone_number": "304-842-1921",
            "fax_number": "304-842-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 CHENOWETH DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301885",
            "telephone_number": "304-842-1921",
            "fax_number": "304-842-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND ADOLESCENT DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-27",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "MOMEN",
        "authorized_official_first_name": "MOE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-842-1921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deepkumar Ajaykumar Patel, MBBS
• Sidney Patterson
• Angela Kristine Paugh
• Ivy Riccole Paugh
• Timothy M Peasak, D.O.
• Pediatric Associate
• Pediatric Associate
• Wesley S Pepper, D.C.
• Azalee Perrine, CM
• Christel Pervola

• Dental Clinic/Center in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Dental Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.