Pediatric Dental Group Ii, LLC
NPI #1912553215 in Midwest City, Oklahoma
Provider Information
- NPI Number
- 1912553215
- Entity Type
- Organization
- Organization Name
- Pediatric Dental Group Ii, LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- PEDIATRIC DENTAL GROUP II, LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Aug 13, 2019
- Last Updated
- Mar 30, 2020
Practice Location
- Address
- 1200 S AIR DEPOT BLVD
- City
- Midwest City
- State
- Oklahoma
- ZIP Code
- 73110-4866
- Phone
- (918) 872-7009
Authorized Official
- Name
- SHAUN URBANOZO
- Title
- CREDENTIALING MANAGER
- Phone
- (719) 323-2362
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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