| Name | Value |
|---|---|
| PROVIDER TYPE | Dental Providers |
| CLASSIFICATION | Dentist |
| 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. |
| AREA OF SPECIALIZATION | Pediatric Dentistry |
| STATUS | Active |
| VA CODE | V030506 |
| X12 CODE | 1223P0221X |
| SPECIALTY CODE | C5 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252486 |
| EFFECTIVE DATE/TIME |
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