Dental Provider Resources 5, PLLC

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Legal business name

DENTAL PROVIDER RESOURCES 5, PLLC

Doing business as

Waterway Dental Care

Practice address

26219 Interstate 45
The Woodlands, TX 77380-1903

Phone

(817) 328-6150

NPI assigned

Mar 26, 2013

Last updated

Apr 1, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jared Bruggeman, DDS

Title

Owner/Doctor

Phone

(817) 328-6153

Specialties & licenses 1

Addresses

Other names 1

• Waterway Dental Care Doing business as

Locations

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1023350212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 TEXAN TRL",
            "address_2": "STE 229",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513776",
            "telephone_number": "817-328-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26219 INTERSTATE 45",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773801903",
            "telephone_number": "817-328-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROVIDER RESOURCES 5, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-26",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "BRUGGEMAN",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "817-328-6153",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterway Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carlo Greg Niepes Demandante, M.D.
• Kinley Jean Deming
• Dennis L. Coburn, PH.D. & Associates
• Kandis Dennis
• Kendall Deran Denson, N/A
• Dental Specialists of the Woodlands
• Dentistry and Orthodontics, PLLC
• Sctrag Dermendjian, D.D.S.
• Robert Gary Dernick, DDS
• Jennifer Derryberry

• Public Health Dentistry in The Woodlands, TX
• Providers in The Woodlands, TX by specialty
• Public Health Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; 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.