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PEDIATRIC DENTAL GROUP, LLC
NPI 1609018548
Dentist - Pediatric Dentistry in Tulsa, OK

Active since March 24, 2009
1421 E 13TH ST, TULSA, OK 74120(918) 585-3744(918) 585-3774 Get Directions Write a Review

NPPES record last updated: March 24, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Pediatric Dental Group, Llc NPPES

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

PEDIATRIC DENTAL GROUP, LLC (NPI 1609018548) is a healthcare organization registered as a pediatric dentistry in Tulsa, Oklahoma and active in the NPI registry since March 2009. The organization lists Charles R Keithline, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1609018548
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NamePEDIATRIC DENTAL GROUP, LLC
Location Address1421 E 13TH STTulsa, OK 74120-5207
Mailing Address1421 E 13th StTulsa, OK 74120-5207 · (918) 585-3744 · Fax (918) 585-3774
Phone(918) 585-3744
Fax(918) 585-3774
Organization SubpartNo
Authorized OfficialCharles R KeithlineManaging Member · (918) 585-3744
Enumeration DateMarch 24, 2009
✔ NPI 1609018548 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in OK · 784
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.
1421 E 13TH ST, Tulsa, OK 74120
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Other Identifiers 1

Medicaid100635530COK

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 Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

Other Providers at the Same Location NPPES 3

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

OB DENTAL, LLC
Dentist (General Practice)
1421 E 13TH ST
TULSA, OK 74120
Tulsa County (918) 585-3744
KEITHLINE DIGITAL IMAGING LLC
Dentist (Oral and Maxillofacial Radiology)
1421 E 13TH ST
TULSA, OK 74120
Tulsa County (918) 585-3744
DR. CHARLES R. KEITHLINE DDS
Dentist (Pediatric Dentistry)
1421 E 13TH ST
TULSA, OK 74120
Tulsa County (918) 585-3744

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 Pediatric Dental Group, LLC's NPI number?

The NPI number for Pediatric Dental Group, LLC is 1609018548. It was assigned to this organization in the NPPES registry on March 24, 2009.

Where is Pediatric Dental Group, LLC located?

Pediatric Dental Group, LLC is located at 1421 E 13th St, Tulsa, OK 74120. The listed phone number is (918) 585-3744.

What is Pediatric Dental Group, LLC's specialty?

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

What insurance does Pediatric Dental Group, LLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Pediatric Dental Group, 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 Pediatric Dental Group, LLC was last updated on March 24, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.