PEDIATRIC DENTAL ASSOCIATES, LLP (NPI# 1003031527) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003031527 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTAL ASSOCIATES, LLP |
| Practice Address |
5 Doctor Cir Longview TX 75605-5050 |
| Practice Telephone | 9037586406 |
| Practice Fax Number | 9037588116 |
| Mailing Telephone | 9037586406 |
| Mailing Fax Number | 9037588116 |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JASON R HORNE (OWNER) |
| Authorized Official Telephone | 9037586406 |
| Authorized Official Credential | D.D.S |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
20796 | TX | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
13954 | TX | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
18784 | TX | Dental Providers |
| Street Address |
5 DOCTOR CIR |
| City | LONGVIEW |
| State | TX |
| Zip Code | 75605-5050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023163524 | Justin Ray Horne | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2007-01-24 |
| 1194129627 | Fadal Pediatric Dentistry, Pa | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2014-10-13 |
| 1528476348 | Horne & Miner Pediatric Dentristy, LLP | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2014-07-24 |
| 1104951284 | Philip John Thomas | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2007-02-22 |
| 1306981170 | Jennifer Ann Rogers | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2007-02-20 |
| 1982759379 | Ronald Nelson Fadal | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194353730 | Dusty Rae Hane | Nurse Practitioner | Diagnostic Clinic of Longview, 2901 N Fourth St, Longview, TX 75605 | 2020-03-30 |
| 1831720374 | Kaycee Whatley | Nurse Practitioner | 323 W Hawkins Parkway, Longview, TX 75605 | 2020-02-03 |
| 1245733492 | Somers Pediatrics | Pediatrics | 103 W. Loop 281, Suite 474, Longview, TX 75605 | 2018-03-14 |
| 1467838391 | Piney Woods Er II LLC | Clinic/Center | 120 East Loop 281, Longview, TX 75605 | 2015-08-03 |
| 1386023968 | Elizabeth Ann Heeb Tidwell | Obstetrics & Gynecology | 802 Medical Dr Ste 100, Longview, TX 75605 | 2015-05-28 |
| 1215353651 | Tracy Hicks | Nurse Practitioner | 102 Commander Dr Ste 9, Longview, TX 75605 | 2014-03-10 |
| 1073881280 | Deirdre Scotter | Specialist/Technologist | 201 E Tomlinson Pkwy, Longview, TX 75605 | 2011-12-02 |
| 1316230139 | Traditions Hospice of Longview, LLC | Hospice Care, Community Based | 4362 N Us Hwy 259, Suite B, Longview, TX 75605 | 2011-05-26 |
| 1184916769 | Telema Dikibujiri Nga | Pediatrics | Longview Regional Medical Center, 2901 North Fourth Street, Longview, TX 75605 | 2011-05-13 |
| 1902101108 | The Veta Lewis Behavioral Health Group | Counselor | 1800 S. Judson St., Suite 100, Longview, TX 75605 | 2011-01-19 |
| Find all providers in zip 75605 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023163524 | Justin Ray Horne | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2007-01-24 |
| 1740338003 | Joshua Richard Miner | Dentist | 5 Doctor Circle, Longview, TX 75605 | 2007-01-05 |
| 1225030455 | Mcgough & Mcgough, P.C. | Dentist | 2392 H G Mosley Pkwy, Longview, TX 75604-3661 | 2005-06-01 |
| 1063056711 | Peeyush Ranjan | Dentist | 1717 Olympia Way, Longview, WA 98632-3929 | 2019-11-05 |
| 1679953111 | Yazan Jaber | Dentist | 1717 Olympia Way, 3108, Longview, WA 98632 | 2015-05-29 |
| 1194129627 | Fadal Pediatric Dentistry, Pa | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2014-10-13 |
| 1528476348 | Horne & Miner Pediatric Dentristy, LLP | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2014-07-24 |
| 1215290697 | Culberson R Boren Dds Pa | Dentist | 705 E Marshall Ave, Medical Plaza IIi, Longview, TX 75601-5573 | 2012-06-20 |
| 1134380421 | Katherine Renee Mcgough | Dentist | 2392 H G Mosley Pkwy, Longview, TX 75604-3661 | 2008-06-19 |
| 1104951284 | Philip John Thomas | Dentist | 5 Doctor Cir, Longview, TX 75605-5050 | 2007-02-22 |
| Find all providers in LONGVIEW | ||||
Please comment or provide details below to improve the information on PEDIATRIC DENTAL ASSOCIATES, LLP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.