Pediatric Dental Group II, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

32 Issued in OK

Legal business name

PEDIATRIC DENTAL GROUP II, LLC

Practice address

7715 E 91St St Ste a
Tulsa, OK 74133-6060

Phone

(918) 585-3744

NPI assigned

Jun 22, 2015

Organization subpart

No

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

Authorized official

Name

Shaun Urbanozo

Title

Credentialing Manager

Phone

(719) 323-2362

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pediatric Dental Group II, LLC Doing business as

Tax ID family

Pediatric Dental Group II 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 Dental Group II, LLC

  • Dental Clinic/Center
  • Midwest City, OK
  • NPI 1912553215
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Pediatric Dental Group II, LLC

  • Dental Clinic/Center
  • Midwest City, OK
  • NPI 1912553215
  NPPES parent name

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585526400000",
    "number": "1760864235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "719-576-1850",
            "fax_number": "719-955-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7715 E 91ST ST STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741336060",
            "telephone_number": "918-585-3744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 S Air Depot Blvd",
            "address_purpose": "LOCATION",
            "city": "Midwest City",
            "state": "OK",
            "postal_code": "731104866",
            "country_code": "US",
            "telephone_number": "918-585-3744",
            "fax_number": "918-585-3774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL GROUP II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-22",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A",
        "authorized_official_last_name": "URBANOZO",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-323-2362"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OK",
            "license": "32",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OK DENTAL LICENSE",
            "identifier": "3942",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dental Group II, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morna Ruth Pederson-Rambo, MA, LPC, LMFT
• 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, LLC
• Pediatric Dentistry of Tulsa P.C.
• Pediatric Occupational Therapy, LLC
• Pediatric Ophthalmology, PC
• Pediatric Ophthalmology, PC

• 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 30, 2020; 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.