NPIMap

Organization Active NPI

Dazzle Dental Care, PA

  • Dentist
  • Flower Mound, TX
National Provider Identifier
1043479066
Registry record updated Apr 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22585 Issued in TX
Legal business name
DAZZLE DENTAL CARE, PA
Practice address
1121 Flower Mound Rd
Suite 500
Flower Mound, TX 75028-3504
Phone
(972) 355-8568
NPI assigned
Jun 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2011

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

Authorized official

Name
Dr. Johnie M Nguyen, DDSNPI 1013995505
Title
President/ Dentist
Phone
(972) 355-8568

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 22585 TX Primary

Addresses

Primary practice location

1121 Flower Mound Rd
Suite 500
Flower Mound, TX 75028-3504

Mailing address

1121 Flower Mound Rd
Suite 500
Flower Mound, TX 75028-3504
Phone (972) 355-8568

Other identifiers 1

IdentifierTypeStateIssuer
201339301MedicaidTX

National Provider Directory

National Provider Directory

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": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303689600000",
    "number": "1043479066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 FLOWER MOUND RD",
            "address_2": "SUITE 500",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750283504",
            "telephone_number": "972-355-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 FLOWER MOUND RD",
            "address_2": "SUITE 500",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750283504",
            "telephone_number": "972-355-8568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAZZLE DENTAL CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2011-04-25",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "JOHNIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/ DENTIST",
        "authorized_official_telephone_number": "972-355-8568",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "22585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201339301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flower Mound, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2011; 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.