NPIMap

Organization Active NPI

Orthodontic Specialists of Seguin, P.a.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Seguin, TX
National Provider Identifier
1063560514
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
15902 Issued in TX
Legal business name
ORTHODONTIC SPECIALISTS OF SEGUIN, P.A.
Practice address
205 S State Highway 46
Seguin, TX 78155-7504
Phone
(830) 372-9811
Fax
(830) 303-0149
NPI assigned
Jan 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Clark D Colville, D.D.S., M.S.NPI 1689728909
Title
Owner President
Phone
(830) 372-9811

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
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 15902 TX Primary

Addresses

Primary practice location

205 S State Highway 46
Seguin, TX 78155-7504

Mailing address

205 S State Highway 46
Seguin, TX 78155-7504
Phone (830) 372-9811

National Provider Directory

National Provider Directory

Locations

205 S State Highway 46
Seguin, TX 78155
Phone (830) 372-9811

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063560514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 S STATE HIGHWAY 46",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781557504",
            "telephone_number": "830-372-9811",
            "fax_number": "830-303-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S STATE HIGHWAY 46",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781557504",
            "telephone_number": "830-372-9811",
            "fax_number": "830-303-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHODONTIC SPECIALISTS OF SEGUIN, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLVILLE",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "830-372-9811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "15902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seguin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.