NPIMap

Organization Active NPI

Tailwater Practice Partners

  • Dental Clinic/Center
  • Rolla, MO
National Provider Identifier
1073393336
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
TAILWATER PRACTICE PARTNERS
Practice address
1701 E 10TH St
Rolla, MO 65401-4601
Phone
(573) 364-1599
NPI assigned
Oct 4, 2023
Organization subpart
Yes
Parent organization
TW NEW DENTISTRY, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Mr. Ryan McCostlin
Title
Ceo
Phone
(615) 479-2196

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1701 E 10TH St
Rolla, MO 65401-4601

Mailing address

10 Burton Hills Blvd Ste 400
Nashville, TN 37215-3004
Phone (615) 479-2196

Other names 1

  • Rolla Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tailwater Practice Partners11 organizations share this tax ID, including this one
Part of
Tailwater Practice Partners

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1073393336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 BURTON HILLS BLVD STE 400",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372153004",
            "telephone_number": "615-479-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014601",
            "telephone_number": "573-364-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAILWATER PRACTICE PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TW NEW DENTISTRY, PLLC",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "MCCOSTLIN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-479-2196",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rolla Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.