Sjt Pediatric Dentistry LLC
NPI 1154804755ActiveOrganization· Dentist, Pediatric Dentistry· Albuquerque, NM
Dentist, Pediatric Dentistry in Albuquerque, New Mexico, registered in NPPES in September 2018. The authorized official on file is Ebonie Gonzales, Credentialing Manager.
Overview
| NPI | 1154804755 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 10, 2018 |
| Last updated in NPPES | Mar 25, 2024 |
| Certified by provider | Mar 25, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Pediatric Dentistry Primary | 1223P0221X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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