| NPI | 1427512060 |
|---|---|
| Doing Business As | PEDIATRIC DENTAL GROUP, LLC |
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE SOUDER Credentialing Manager 719-649-0305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2019-01-28 |