Pediatric Dentistry Associates, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

7814 Issued in CT

Legal business name

PEDIATRIC DENTISTRY ASSOCIATES, LLC

Practice address

991 State St
New Haven, CT 06511-3993

Phone

(203) 787-3669

Fax

(203) 785-8416

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Douglas B. Keck, D.M.D.

Title

Owner

Phone

(203) 787-3669

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Pediatric Dentistry Associates LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Pediatric Dentistry Associates, LLC

  • Pediatric Dentistry
  • Madison, CT
  • NPI 1982759791
  NPD tax ID

Locations

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1740334002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 STATE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113993",
            "telephone_number": "203-787-3669",
            "fax_number": "203-785-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 STATE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113993",
            "telephone_number": "203-787-3669",
            "fax_number": "203-785-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "KECK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-787-3669",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "5525",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "7814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1184624058",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1710988704",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Sara Peck, LCSW
• Signy M Peck, LCSW
• Earlene Jane Peckham, APRN,CPNP,MSN
• Marie Elisabeth Peddinghaus, MD
• Pediatric & Medical Associates, P.C.
• Pediatric Psychology of Connecticut, LLC
• Prachi Mangesh Pednekar, M.D.
• Caroline J Peh, PA
• Aldo Jose Peixoto, MD
• Richard R Pelker, MD

• Pediatric Dentistry in New Haven, CT
• Providers in New Haven, CT by specialty
• Pediatric Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; 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.