Your Houston Dentist

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8242 Issued in TX

Legal business name

YOUR HOUSTON DENTIST

Practice address

2077 S Gessner Rd
Suite 125
Houston, TX 77063-1147

Phone

(713) 789-1200

Fax

(713) 789-1219

NPI assigned

Jan 2, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bradley Rix Wilson, DDS, MSDNPI 1053329185

Title

Owner

Phone

(713) 789-1200

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bradley Rix Wilson, DDS, MSD

  • General Practice Dentistry
  • Broken Arrow, OK
  • NPI 1053329185
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201046400000",
    "number": "1003091604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2077 S GESSNER RD",
            "address_2": "SUITE 125",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770631147",
            "telephone_number": "713-789-1200",
            "fax_number": "713-789-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2077 S GESSNER RD",
            "address_2": "SUITE 125",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770631147",
            "telephone_number": "713-789-1200",
            "fax_number": "713-789-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR HOUSTON DENTIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2008-01-23",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "RIX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-789-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "8242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1053329185",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Houston, TX
• Providers in Houston, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.