NPIMap

Organization Active NPI

Preece Church and Associates, Pediatric Dentistry

  • Pediatric Dentistry
  • Fort Worth, TX
National Provider Identifier
1043754740
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
17828 Issued in TX
Legal business name
PREECE CHURCH AND ASSOCIATES, PEDIATRIC DENTISTRY
Practice address
5700 Edwards Ranch Rd
Suite 100
Fort Worth, TX 76109-4127
Phone
(817) 292-2004
NPI assigned
Dec 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Authorized official

Name
Dr. George Stanley Preece, DDS
Title
Manager
Phone
(817) 292-2004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 17828 TX Primary

Addresses

Primary practice location

5700 Edwards Ranch Rd
Suite 100
Fort Worth, TX 76109-4127

Mailing address

5700 Edwards Ranch Rd
Suite 100
Fort Worth, TX 76109-4127
Phone (817) 292-2004

Other identifiers 6

IdentifierTypeStateIssuer
1407863806OtherNPI, TYPE 1
1881949592OtherNPI, TYPE 1
2168825-01MedicaidTX
0912362-03MedicaidTX
3608952-01MedicaidTX
1245251362OtherTXNPI, TYPE 1

National Provider Directory

National Provider Directory

Locations

5700 Edwards Ranch Rd
Ste 100
Fort Worth, TX 76109
Phone (817) 292-2004

Practitioners & affiliated clinicians

Practitioners 3

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": "1481673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1043754740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 EDWARDS RANCH RD",
            "address_2": "SUITE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094127",
            "telephone_number": "817-292-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 EDWARDS RANCH RD",
            "address_2": "SUITE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094127",
            "telephone_number": "817-292-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREECE CHURCH AND ASSOCIATES, PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-14",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "PREECE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "817-292-2004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "17828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI, TYPE 1",
            "identifier": "1407863806",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI, TYPE 1",
            "identifier": "1881949592",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2168825-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0912362-03",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3608952-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI, TYPE 1",
            "identifier": "1245251362",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; 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.