# PEDIATRIC DENTAL GROUP II, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PEDIATRIC DENTAL GROUP II, LLC
- **Other names:** Adventure Dental of Midwest City
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912553215
- **Legal business name:** PEDIATRIC DENTAL GROUP II, LLC
- **Authorized official:** SHAUN URBANOZO (CREDENTIALING MANAGER)
- **Authorized official phone:** (719) 323-2362

## Contact information

- **Practice address:** 1200 S AIR DEPOT BLVD, MIDWEST CITY, OK 73110-4866
- **Practice address phone:** (918) 872-7009
- **Mailing address:** 2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
- **Mailing address phone:** (719) 576-1850
- **Mailing address fax:** (719) 955-3470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/13/2019
- **Last updated:** 03/30/2020