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ABQ PEDIATRIC DENTISTRY
NPI 1154804755
Dentist - Pediatric Dentistry in Albuquerque, NM

Active since September 10, 2018
4620 JEFFERSON LN NE STE C, ALBUQUERQUE, NM 87109(505) 888-3520 Get Directions Write a Review

NPPES record last updated: March 25, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 23, 2022, Jul 6, 2020, Sep 10, 2018 (3 updates tracked since 2018).

About Abq Pediatric Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ABQ PEDIATRIC DENTISTRY (NPI 1154804755) is a healthcare organization registered as a pediatric dentistry in Albuquerque, New Mexico and active in the NPI registry since September 2018. The organization lists Ebonie Gonzales, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1154804755
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameSJT PEDIATRIC DENTISTRY LLC
Location Address4620 JEFFERSON LN NE STE CAlbuquerque, NM 87109-2149
Mailing Address4620 Jefferson Ln Ne Ste CAlbuquerque, NM 87109-2149 · (505) 850-3769 · Fax (505) 890-2949
Phone(505) 888-3520
Organization SubpartNo
Authorized OfficialEbonie GonzalesCredentialing Manager · (505) 850-3769
Enumeration DateSeptember 10, 2018
Last NPPES UpdateMarch 25, 20243 updates tracked since enumeration
NPPES CertifiedMarch 25, 2024
✔ NPI 1154804755 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Definition
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.
4620 JEFFERSON LN NE STE C, Albuquerque, NM 87109
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Other Names 1

Doing Business AsAbq Pediatric Dentistry

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. COLIN SIMEON SHAW D.M.D
Dentist (Endodontics)
4620 JEFFERSON LN NE STE C
ALBUQUERQUE, NM 87109
Bernalillo County (505) 888-3395
DR. AUDREY MAE N RAWSON D.D.S.
Dentist (Pediatric Dentistry)
4620 JEFFERSON LN NE STE C
ALBUQUERQUE, NM 87109
Bernalillo County (505) 888-3520
OHANA ORTHODONTICS LLC
Dentist (Orthodontics and Dentofacial Orthopedics)
4620 JEFFERSON LN NE STE C
ALBUQUERQUE, NM 87109
Bernalillo County (505) 888-3520
RAWSON PEDIATRIC DENTAL GROUP
Dentist (Pediatric Dentistry)
4620 JEFFERSON LN NE STE C
ALBUQUERQUE, NM 87109
Bernalillo County (505) 888-3520

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sjt Pediatric Dentistry LLC's NPI number?

The NPI number for Sjt Pediatric Dentistry LLC is 1154804755. It was assigned to this organization in the NPPES registry on September 10, 2018. The provider is doing business as Abq Pediatric Dentistry.

Where is Sjt Pediatric Dentistry LLC located?

Sjt Pediatric Dentistry LLC is located at 4620 Jefferson Ln NE Ste C, Albuquerque, NM 87109. The listed phone number is (505) 888-3520.

What is Sjt Pediatric Dentistry LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

What insurance does Sjt Pediatric Dentistry LLC accept?

Health plans from UnitedHealthcare list Sjt Pediatric Dentistry LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sjt Pediatric Dentistry LLC was last updated on March 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.