Mitchell W Ponsford, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

31434 Issued in TX

Practice address

248 N Main St Ste 1
Boerne, TX 78006

Phone

(830) 816-5102

NPI assigned

Sep 17, 2015

Last updated

Jul 19, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1073982252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 N MAIN ST STE 1",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062036",
            "telephone_number": "830-816-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 N MAIN ST STE 1",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78006",
            "telephone_number": "830-816-5102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3302 Gaston Ave",
            "address_2": "Graduate Periodontics",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752462013",
            "country_code": "US",
            "telephone_number": "915-526-0120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PONSFORD",
        "first_name": "MITCHELL",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-17",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "31434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Platnick, OT
• Bailey Plummer, OTR
• Olivia Polk, RBT
• Grace Pomager, RN
• Gerardo Ponce
• Autumn Postell, PA
• Sue A Potter
• Kiley M Pradon, DPT
• Premier Boerne Dental, PLLC (Premier Dental Boerne)
• Premier Physical Therapy & Wellness, LLC

• Periodontics in Boerne, TX
• Providers in Boerne, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.