NPIMap

Organization Active NPI

Shepherd Lane Dental Associates,P.C

  • General Practice Dentistry
  • Mesquite, TX
National Provider Identifier
1073642013
Registry record updated Jul 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7005 Issued in TX
Legal business name
SHEPHERD LANE DENTAL ASSOCIATES,P.C
Practice address
3434 Towne Crossing Blvd.
Suite 106
Mesquite, TX 75150-2724
Phone
(972) 279-0900
Fax
(972) 286-6106
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2015

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

Authorized official

Name
Harry J. Blanek, D.D.S.
Title
Owner
Phone
(972) 279-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 7005 TX Primary

Addresses

Primary practice location

3434 Towne Crossing Blvd.
Suite 106
Mesquite, TX 75150-2724

Mailing address

3434 Towne Crossing Blvd.
Suite 106
Mesquite, TX 75150-2724
Phone (972) 286-5711

Other identifiers 1

IdentifierTypeStateIssuer
091321202MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Shepherd Lane Dental Associates8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437177600000",
    "number": "1073642013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 TOWNE CROSSING BLVD.",
            "address_2": "SUITE 106",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751502724",
            "telephone_number": "972-286-5711",
            "fax_number": "972-286-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 TOWNE CROSSING BLVD.",
            "address_2": "SUITE 106",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751502724",
            "telephone_number": "972-279-0900",
            "fax_number": "972-286-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPHERD LANE DENTAL ASSOCIATES,P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2015-07-18",
        "status": "A",
        "authorized_official_last_name": "BLANEK",
        "authorized_official_first_name": "HARRY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-279-0900",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "7005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091321202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesquite, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2015; 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.