NPIMap

Organization Active NPI

Pediatric Dentistry P.L.C.

  • Pediatric Dentistry
  • Sartell, MN
National Provider Identifier
1780938688
Registry record updated Oct 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D12500 Issued in MN
Legal business name
PEDIATRIC DENTISTRY P.L.C.
Practice address
151 19TH St S
Sartell, MN 56377-2153
Phone
(320) 229-2222
Fax
(888) 563-2069
NPI assigned
Oct 31, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2012

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

Authorized official

Name
Liliana Lucas
Title
Dentist
Phone
(320) 229-2222

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X D12500 MN Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X D12249 MN

Addresses

Primary practice location

151 19TH St S
Sartell, MN 56377-2153

Mailing address

151 19TH St S
Sartell, MN 56377-2153

National Provider Directory

National Provider Directory

Locations

151 19th St S
Sartell, MN 56377
Phone (320) 229-2222

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1780938688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 19TH ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 19TH ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772153",
            "telephone_number": "320-229-2222",
            "fax_number": "888-563-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY P.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-31",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "LUCAS",
        "authorized_official_first_name": "LILIANA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "320-229-2222"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D12500",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D12249",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.