PEDIATRIC DENTAL GROUP, PC (NPI# 1427591031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427591031 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTAL GROUP, PC |
| Other Organization Name | MY PEDIATRIC DENTIST |
| Practice Address |
1411 J F Kennedy Dr Bellevue NE 68005-3639 |
| Mailing Address |
1411 Jfk Drive Bellevue NE 68005-0011 |
| Practice Telephone | 4022916577 |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2016-11-30 |
| Authorized Official Name | DR. RYAN THOMAS HAJEK (OWNER) |
| Authorized Official Telephone | 6053547077 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
7030 | NE | Dental Providers |
| Other Name | Type Code |
|---|---|
| My Pediatric Dentist | Doing Business As Name - Organization |
| Street Address |
1411 J F KENNEDY DR |
| City | BELLEVUE |
| State | NE |
| Zip Code | 68005-3639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871572594 | Jason John Carpenter | Dentist | 1411 J F Kennedy Dr, Bellevue, NE 68005-3639 | 2006-01-11 |
| 1962939835 | Elizabeth A Kampschnieder | Dentist | 1411 J F Kennedy Dr, Bellevue, NE 68005-3639 | 2017-05-22 |
| 1932588969 | Ashley M. Tietgen | Dentist | 1411 J F Kennedy Dr, Bellevue, NE 68005-3639 | 2015-05-22 |
| 1497076079 | Cameron James Thomas | Dentist | 1411 J F Kennedy Dr, Bellevue, NE 68005-3639 | 2010-06-17 |
| 1215170055 | Toni G Van Horn | Dental Hygienist | 1411 J F Kennedy Dr, Bellevue, NE 68005-3639 | 2009-04-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750988325 | Melissa Ann Jansen | Social Worker | Mission Middle School, Bellevue, NE 68005 | 2020-10-06 |
| 1295352144 | Angel Lowery | Counselor | 112 E Mission Ave, Bellevue, NE 68005 | 2020-06-26 |
| 1760915656 | Maria Clark | Counselor | 1620 Wilshire Dr Ste 222, Bellevue, NE 68005 | 2017-04-06 |
| 1427420512 | Daryan Whaler | Specialist/Technologist | 1000 Galvin Rd S, Bellevue, NE 68005 | 2015-10-28 |
| 1750704623 | Joseph Gavis Councill IIi | Nurse Practitioner | 919 Galvin Rd. S., Suite A, Bellevue, NE 68005 | 2014-01-29 |
| 1205265501 | Rebecca Parsons | Speech-Language Pathologist | 510 W 22nd Avenue, Bellevue, NE 68005 | 2013-11-06 |
| 1649524174 | Tammy Lee Winkler-bitzes | Physical Therapist | 1820 Hillcrest Dr Suite A, Belleuve, NE 68005 | 2012-11-06 |
| 1811268311 | Charice M Butler | Counselor | 919 Galvin Rd S. Ste A, Bellevue, NE 68005 | 2012-01-16 |
| 1184991945 | Angela M Matney | Pharmacist | Hwy 370 & Galvin Road, Bellevue, NE 68005 | 2011-11-22 |
| 1770878852 | Sarah Cathryn Sedlak | Physical Therapist | 2206 Longo Drive, Ste 211, Excel Physical Therapy, Bellevue, NE 68005 | 2011-06-16 |
| Find all providers in zip 68005 | ||||
| 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 |
|---|---|---|---|---|
| 1568848463 | Yu Ong | Dentist | 914 140th Ave Ne Ste 101, Bellevue, WA 98005-3482 | 2015-08-03 |
| 1841571254 | Lisa Yu Dds PC | Dentist | 12826 Se 40th Ln Ste 101, Bellevue, WA 98006-5266 | 2011-08-31 |
| 1508012063 | Sue Jeong Choi | Dentist | 5204 Somerset Dr Se, Bellevue, WA 98006-4259 | 2008-08-14 |
| 1922260793 | Sookyung Jun | Dentist | 1500 145th Pl Se, Bellevue, WA 98007-5516 | 2008-07-01 |
| 1568587897 | James Michael Thomas | Dentist | 1200 112th Ave Ne Ste C250, Bellevue, WA 98004-3741 | 2007-03-19 |
| 1427113141 | Todd B Krekow | Dentist | 11102 Ne 38th Pl, Bellevue, WA 98004-7653 | 2006-12-22 |
| 1871662544 | Jimmy S Yun | Dentist | 12600 Se 38th St Ste 110, Bellevue, WA 98006-5232 | 2006-11-07 |
| 1306926449 | Jenny Hee-jae Lee | Dentist | 2150 112 Ave Ne # A, Bellevue, WA 98004-2939 | 2006-10-16 |
| 1497866255 | Lawrence E Mast Dds Ps | Dentist | 2150 112 Ave Ne #a, Bellevue, WA 98004 | 2006-08-31 |
| 1003841347 | Alicia K Wong | Dentist | 914 140th Ave Ne, Suite 101, Bellevue, WA 98005-3482 | 2006-07-12 |
| Find all providers in BELLEVUE | ||||
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| 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.