NPIMap

Organization Active NPI

Tate Family Dentistry, PA

  • General Practice Dentistry
  • Southlake, TX
National Provider Identifier
1003811100
Registry record updated Dec 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
TX11540 Issued in TX
Legal business name
TATE FAMILY DENTISTRY, PA
Practice address
3101 E State Highway 114
Ste a
Southlake, TX 76092-6690
Phone
(817) 481-6364
Fax
(817) 329-2296
NPI assigned
Jun 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2014

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

Authorized official

Name
Dr. John Tyler Tate, D.D.S.NPI 1376837807
Title
Secretary
Phone
(817) 481-6364

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X TX11540 TX Primary

Addresses

Primary practice location

3101 E State Highway 114
Ste a
Southlake, TX 76092-6690

Mailing address

3101 E State Highway 114
Ste a
Southlake, TX 76092-6690
Phone (817) 481-6364

Other identifiers 2

IdentifierTypeStateIssuer
TX26565OtherTXDENTAL LICENSE NUMBER
TX11540OtherTXDENTAL LICENSE NUMBER

Other names 1

  • John Michael Tate DDS Pa Former legal business name

National Provider Directory

National Provider Directory

Locations

3101 E State Highway 114
Ste A
Southlake, TX 76092
Phone (817) 481-6364

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418601600000",
    "number": "1003811100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 E STATE HIGHWAY 114",
            "address_2": "STE A",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926690",
            "telephone_number": "817-481-6364",
            "fax_number": "817-329-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 E STATE HIGHWAY 114",
            "address_2": "STE A",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926690",
            "telephone_number": "817-481-6364",
            "fax_number": "817-329-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TATE FAMILY DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2014-12-15",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "817-481-6364",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "TX11540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "TX26565",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "TX11540",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John Michael Tate DDS Pa",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.