Pediatric Dental Specilaist, P.C
NPI 1255063244ActiveOrganization· Dentist, Pediatric Dentistry· Port Huron, MI
Dentist, Pediatric Dentistry in Port Huron, Michigan, registered in NPPES in June 2022. The authorized official on file is Kacey A. Woodward, Receptionist.
Overview
| NPI | 1255063244 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 28, 2022 |
| Last updated in NPPES | Jul 26, 2022 |
| Certified by provider | Jul 26, 2022 |
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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