Pediatric Dentistry PC

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

M991 Issued in SD

Legal business name

PEDIATRIC DENTISTRY PC

Doing business as

DBA. Dunes Dental 4 Kids

Practice address

711 Sioux Point Rd. Ste. 100
Dakota Dunes, SD 57049-5099

Phone

(605) 242-4700

Fax

(605) 242-4702

NPI assigned

Mar 11, 2014

Organization subpart

No

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

Authorized official

Name

Jeanne S. Hansen

Title

Office Manager

Phone

(605) 242-4700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DBA. Dunes Dental 4 Kids Doing business as

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1962828285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 SIOUX POINT RD. STE. 100",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495099",
            "telephone_number": "605-242-4700",
            "fax_number": "605-242-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 SIOUX POINT RD. STE. 100",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "570495099",
            "telephone_number": "605-242-4700",
            "fax_number": "605-242-4702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "605-242-4700"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "SD",
            "license": "M991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0234450",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA. Dunes Dental 4 Kids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jamie Lund Olsen, D.O.
• Kathryn D Opheim, MD
• Optum Behavioral Care of Ohio, Inc.
• Oral Surgery Assocates, P.C.
• Allison Ruth Owings, NP-C
• Stephanie Marie Peek
• Michael V Persaud, DO
• Jeff Peterson, L.P.C., L.C.P.C.
• Lauren Pfaffle
• Nathan Alexander Phillips, DDS

• Public Health Dentistry in Dakota Dunes, SD
• Providers in Dakota Dunes, SD by specialty
• Public Health Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.