NPIMap

Individual provider Active NPI

Ryan T Hajek, D.D.S.

  • Pediatric Dentistry
  • Council Bluffs, IA
National Provider Identifier
1861749251
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
09125 Issued in IA
Practice address
114 1/2 S 6TH St
Council Bluffs, IA 51501-4234
Phone
(605) 354-7077
NPI assigned
Aug 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 7030 NE
Dentist 122300000X D0985 SD
Pediatric Dentistry 1223P0221X 09125 IA Primary

Addresses

Primary practice location

114 1/2 S 6TH St
Council Bluffs, IA 51501-4234

Mailing address

3351 N 125TH St
Omaha, NE 68164-4288

Other practice location 1

1411 John F Kennedy Drive
Bellevue, NE 68005
Phone (402) 291-6577

Other practice location 2

14270 W Maple Rd
Omaha, NE 68164-2436
Phone (402) 491-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D0985SDMDDentist
09125IAMDPediatric Dentist
7030NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
My Pediatric Dentist West Maple PC Pediatric Dentistry CurrentSince Apr 9, 2024 Accepting new patients
West Maple Dental Specialists Pediatric Dentistry Past Accepting new patients
Pediatric Dental Group, PC Pediatric Dentistry Past Accepting new patients

Locations

14270 W Maple Rd
Omaha, NE 68164
Phone (402) 491-3100

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1861749251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3351 N 125TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681644288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 1/2 S 6TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515014234",
            "telephone_number": "605-354-7077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 John F Kennedy Drive",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "NE",
            "postal_code": "68005",
            "country_code": "US",
            "telephone_number": "402-291-6577",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14270 W Maple Rd",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681642436",
            "country_code": "US",
            "telephone_number": "402-491-3100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAJEK",
        "first_name": "RYAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-06",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "7030",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SD",
            "license": "D0985",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IA",
            "license": "09125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.