NPIMap

Individual provider Active NPI

Carolyn L. Jovanovic, D.D.S.

  • General Practice Dentistry
  • Conroe, TX
National Provider Identifier
1063791267
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
36832 Issued in TX
Practice address
2016 N Loop 336 W
Conroe, TX 77304-3516
Phone
(936) 756-6867
NPI assigned
Aug 5, 2011
Last updated
Mar 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 056115 NY
General Practice Dentistry 1223G0001X 36832 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

2016 N Loop 336 W
Conroe, TX 77304-3516

Mailing address

2016 N Loop 336 W
Conroe, TX 77304-3516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
056115NYMDGeneral Practice Dentistry
36832TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Carolyn L Jovanovic PLLC CurrentSince Mar 16, 2021 Accepting new patients
New Baltimore Family Dentistry, LLP General Practice Past Accepting new patients
Marvin a. Gertzberg, D.D.S. Past Accepting new patients

Locations

2016 N Loop 336 W
Conroe, TX 77304
Phone (936) 756-6867

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1063791267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 N LOOP 336 W",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 N LOOP 336 W",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043516",
            "telephone_number": "936-756-6867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOVANOVIC",
        "first_name": "CAROLYN",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "056115",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36832",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; 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.