NPIMap

Organization Active NPI

FWB Dental, P.L.L.C.

  • General Practice Dentistry
  • Friendswood, TX
National Provider Identifier
1013458983
Registry record updated Mar 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30466 Issued in TX
Legal business name
FWB DENTAL, P.L.L.C.
Practice address
1012 Baybrook Mall
Friendswood, TX 77546-2744
Phone
(281) 461-6515
Fax
(281) 461-6687
NPI assigned
Mar 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2017

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

Authorized official

Name
Dr. Vlada Matytsin, D.D.S.NPI 1003964339
Title
Owner/Dentist
Phone
(281) 461-6515

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 30466 TX Primary

Addresses

Primary practice location

1012 Baybrook Mall
Friendswood, TX 77546-2744

Mailing address

1012 Baybrook Mall
Friendswood, TX 77546-2744
Phone (281) 461-6515

Other names 1

  • Baybrook Mall Dental Other name

National Provider Directory

National Provider Directory
Tax ID family
Baybrook Mall Dental3 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.

Locations

1012 Baybrook Mall
Friendswood, TX 77546
Phone (281) 461-6515

Practitioners & affiliated clinicians

Practitioners 1

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": "1489363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489363200000",
    "number": "1013458983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 BAYBROOK MALL",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775462744",
            "telephone_number": "281-461-6515",
            "fax_number": "281-461-6687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 BAYBROOK MALL",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775462744",
            "telephone_number": "281-461-6515",
            "fax_number": "281-461-6687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FWB DENTAL, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-13",
        "last_updated": "2017-03-13",
        "status": "A",
        "authorized_official_last_name": "MATYTSIN",
        "authorized_official_first_name": "VLADA",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "281-461-6515",
        "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": "30466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baybrook Mall Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Friendswood, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2017; 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.