PDR Greeley PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PDR GREELEY PLLC

Doing business as

Greeley Kids Dental and Orthodontics

Practice address

2003 46TH Ave
Greeley, CO 80634-3250

Phone

(970) 330-4600

Fax

(970) 330-4612

NPI assigned

Feb 15, 2019

Organization subpart

No

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

Authorized official

Name

Keith Van Tassell, DDS

Title

Dentist

Phone

(970) 330-4600

Specialties & licenses 1

Addresses

Other names 1

• Greeley Kids Dental and Orthodontics Doing business as

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

{
    "created_epoch": "1550188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550188800000",
    "number": "1992261820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 46TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806343250",
            "telephone_number": "970-330-4600",
            "fax_number": "970-330-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 46TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806343250",
            "telephone_number": "970-330-4600",
            "fax_number": "970-330-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDR GREELEY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-15",
        "last_updated": "2019-02-15",
        "status": "A",
        "authorized_official_last_name": "VAN TASSELL",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "970-330-4600",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greeley Kids Dental and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ramon Payan
• Becci Sue Payne
• Kyle Payne, ATC
• Alison Payton, MA
• Thomas J Pazik, MD
• Peaceful Paws Therapy, LLC
• Peak Form LLC
• Peake Wellness Center
• Pearle Vision Inc (Pearle Vision #C6310)
• Ethan Pearson

• Pediatric Dentistry in Greeley, CO
• Providers in Greeley, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.