NPIMap

Organization Active NPI

Dental Professionals of Texas, P.a.

Doing business as Tennyson Lake Dental

  • General Practice Dentistry
  • Plano, TX
National Provider Identifier
1043712037
Registry record updated Mar 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF TEXAS, P.A.
Doing business as
Tennyson Lake Dental
Practice address
5044 Tennyson Pkwy Ste a
Plano, TX 75024-2953
Phone
(972) 378-3601
NPI assigned
Mar 6, 2018
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF TEXAS, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2018

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

Authorized official

Name
Cassandra Petersen
Title
Credentialing Team Lead
Phone
(217) 540-8972

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

5044 Tennyson Pkwy Ste a
Plano, TX 75024-2953

Mailing address

5044 Tennyson Pkwy Ste a
Plano, TX 75024-2953

Other names 1

  • Tennyson Lake Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Texas PA13 organizations share this tax ID, including this one
Part of
Dental Professionals of Texas PA

Other organizations with this tax ID 12

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

Locations

5044 Tennyson Pkwy
Ste A
Plano, TX 75024
Phone (972) 378-3601

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520294400000",
    "number": "1043712037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5044 TENNYSON PKWY STE A",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750242953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5044 TENNYSON PKWY STE A",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750242953",
            "telephone_number": "972-378-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF TEXAS, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF TEXAS, P.A.",
        "enumeration_date": "2018-03-06",
        "last_updated": "2018-03-06",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennyson Lake Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; 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.