Pediatric Dentistry, Inc.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

M442 Issued in SD

Legal business name

PEDIATRIC DENTISTRY, INC.

Practice address

1737 S Cleveland Ave
Sioux Falls, SD 57103-3245

Phone

(605) 338-0884

Fax

(605) 338-0240

NPI assigned

Aug 20, 2007

Last updated

Aug 20, 2007By 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. Gayle V Nelson, DDSNPI 1639267925

Title

President

Phone

(605) 338-0884

Specialties & licenses 1

Addresses

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.

• Gayle V Nelson, DDS, MSD

  • Pediatric Dentistry
  • Sioux Falls, SD
  • NPI 1639267925
  NPD (past) Authorized official

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1871786269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1737 S CLEVELAND AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571033245",
            "telephone_number": "605-338-0884",
            "fax_number": "605-338-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1737 S CLEVELAND AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571033245",
            "telephone_number": "605-338-0884",
            "fax_number": "605-338-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-338-0884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SD",
            "license": "M442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Maria Pedersen
• Cole Jason Pederson, COTA
• Jeanette Zespy Pederson, OTR/L
• Kalli Pederson, RDN, LN, CDE
• Kim Pederson, M.D.
• Pediatric Hematology Clinic LTD
• Pediatric Hematology Oncology Pharmacy LTC
• Pediatric Sedation Dentistry of Colorado PLLC
• Pediatric Surgical Associates PC
• Elisa Pedone

• Dental Clinic/Center in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Dental Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; 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.