NPIMap

Organization Active NPI

Glen Rose Family Dental

  • Preferred Provider Organization
  • Glen Rose, TX
National Provider Identifier
1003351271
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
29154 Issued in TX
Legal business name
GLEN ROSE FAMILY DENTAL
Practice address
1104 Bluebonnet St
Glen Rose, TX 76043-5013
Phone
(254) 898-4646
Fax
(254) 897-7321
NPI assigned
Dec 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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

Authorized official

Name
Dr. Clayton K Cook, DMDNPI 1578903217
Title
General Dentist
Phone
(254) 898-4646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 29154 TX Primary

Addresses

Primary practice location

1104 Bluebonnet St
Glen Rose, TX 76043-5013

Mailing address

1104 Bluebonnet St
Glen Rose, TX 76043-5013
Phone (254) 898-4646

National Provider Directory

National Provider Directory
Tax ID family
GBCC Dental PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1482796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482796800000",
    "number": "1003351271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 BLUEBONNET ST",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760435013",
            "telephone_number": "254-898-4646",
            "fax_number": "254-897-7321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 BLUEBONNET ST",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760435013",
            "telephone_number": "254-898-4646",
            "fax_number": "254-897-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ROSE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-27",
        "last_updated": "2016-12-27",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "254-898-4646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "TX",
            "license": "29154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Rose, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; 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.