Atx Pedo PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

ATX PEDO PLLC

Doing business as

Happy Teeth Pediatric Dentistry

Practice address

1217 W Slaughter LN Ste 140
Austin, TX 78748-6577

Phone

(512) 643-8900

NPI assigned

Apr 17, 2019

Organization subpart

No

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

Authorized official

Name

Sarah Theresa DelacruzNPI 1083914410

Title

Manager

Phone

(512) 774-7833

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Happy Teeth Pediatric Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarah Theresa Delacruz, PA

  • Physician Assistant
  • Austin, TX
  • NPI 1083914410
  Authorized official Same address or phone
• Matthew Anthony Lucero, DMD

  • Pediatric Dentistry
  • Aurora, CO
  • NPI 1306158886
  NPD

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

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555459200000",
    "number": "1043873854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 W SLAUGHTER LN STE 140",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787486577",
            "telephone_number": "512-643-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 W SLAUGHTER LN STE 140",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787486577",
            "telephone_number": "512-643-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATX PEDO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-04-17",
        "status": "A",
        "authorized_official_last_name": "DELACRUZ",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "THERESA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "512-774-7833"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286329203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Happy Teeth Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Dentistry in Austin, TX
• Providers in Austin, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; 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.