PEDIATRIC DENTAL GROUP, LLC (NPI# 1609018548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609018548 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTAL GROUP, LLC |
| Practice Address |
1421 E 13th St Tulsa OK 74120-5207 |
| Practice Telephone | 9185853744 |
| Practice Fax Number | 9185853774 |
| Mailing Telephone | 9185853744 |
| Mailing Fax Number | 9185853774 |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2009-03-24 |
| Authorized Official Name | DR. CHARLES R KEITHLINE III (MANAGING MEMBER) |
| Authorized Official Telephone | 9185853744 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
784 | OK | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100635530C | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235697707 | Pediatric Dental Group, LLC | Dentist | 12601 Narcoossee Rd, Unite 100a, Orlando, FL 32832 | 2019-03-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | PEDIATRIC DENTAL GROUP, LLC | 602 S Utica, Tulsa, OK 74104 |
| Street Address |
1421 E 13TH ST |
| City | TULSA |
| State | OK |
| Zip Code | 74120-5207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932269933 | Charles R. Keithline | Dentist | 1421 E 13th St, Tulsa, OK 74120-5207 | 2006-12-11 |
| 1366775140 | Ob Dental, LLC | Dentist | 1421 E 13th St, Tulsa, OK 74120-5207 | 2009-09-11 |
| 1467680231 | Keithline Digital Imaging LLC | Dentist | 1421 E 13th St, Tulsa, OK 74120-5207 | 2009-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144704321 | Quintella Delana Miller | Case Manager/Care Coordinator | 1043 E Easton St, Tulsa, OK 74120 | 2018-09-24 |
| 1689152092 | Charles Granger Jr. | Case Manager/Care Coordinator | 103 N Greenwood, Suite 320, Tulsa, OK 74120 | 2018-07-30 |
| 1174015598 | Debra Anne Beasley | Counselor | 1619 E. 13th St., Tulsa, OK 74120 | 2018-06-01 |
| 1649775701 | Cara Marie Cantu | Licensed Practical Nurse | 620 South Peoria, Tulsa, OK 74120 | 2018-03-29 |
| 1639558745 | Wei Te Li | Student in an Organized Health Care Education/Training Program | 1207 S Quaker Ave Apt 104, Tulsa, OK 74120 | 2015-05-21 |
| 1225434350 | Marcos Rivero | Community/Behavioral Health | 130 N. Greenwood, Suite 302, Tulsa, OK 74120 | 2014-11-18 |
| 1861742348 | Tamiika Jones | Social Worker | 1533 E 13th St, Apt B, Tulsa, OK 74120 | 2012-09-12 |
| 1730408097 | Teresa Lee Henshaw | Physical Therapist | 1125 S. Trenton, Hillcrest Medical Center- Kaiser Rehab. Center, Tulsa, OK 74120 | 2010-05-26 |
| 1194970384 | Kym Lynnette Lindsay | Speech-Language Pathologist | 1125 S Trenton Ave Fl 3, Tulsa, OK 74120 | 2008-12-01 |
| 1184872004 | Board of Regents of The University of Oklahoma Ou Physicians Tulsa | Pediatrics | 619 S. Quincy Ave., Ouptch-laura Dester Shelter, Tulsa, OK 74120 | 2008-09-04 |
| Find all providers in zip 74120 | ||||
| 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 |
|---|---|---|---|---|
| 1760864235 | Pediatric Dental Group II, LLC | Dentist | 7715 E 91st St Ste A, Tulsa, OK 74133-6060 | 2015-06-22 |
| 1548472137 | James F. Owens Dds Ms PC | Dentist | 10507 E 91st Street Suite 410, Tulsa, OK 74133 | 2007-05-04 |
| 1235283524 | Thomas Harold Gilbert Sr. | Dentist | 7116 S Mingo Rd, # 112, Tulsa, OK 74133 | 2007-01-23 |
| 1932269933 | Charles R. Keithline | Dentist | 1421 E 13th St, Tulsa, OK 74120-5207 | 2006-12-11 |
| 1356351662 | Mlk Dentistry Inc | Dentist | 2930 S Pittsburg Ave, Tulsa, OK 74114 | 2006-08-09 |
| 1750326690 | Sarah M Fox | Dentist | 6585 S Yale Ave Ste 510, Tulsa, OK 74136-8384 | 2006-06-17 |
| 1598742751 | James George Steyer Jr. | Dentist | 10127 S Yale Ave, Tulsa, OK 74137-6002 | 2005-12-29 |
| 1881688513 | Gary Wallace Fisher | Dentist | 1203 E 33rd St, Ste 100, Tulsa, OK 74105-2040 | 2005-09-08 |
| 1376542928 | Ronald Lynn Winder | Dentist | 5602 S Memorial Dr, Tulsa, OK 74145-9016 | 2005-07-17 |
| 1992368278 | On The Cusp Midtown Pllc | Dentist | 4444 S Harvard Ave, Tulsa, OK 74135-2634 | 2019-04-22 |
| Find all providers in TULSA | ||||
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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.