Gulfside Dental - la Marque PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GULFSIDE DENTAL - LA MARQUE PLLC

Practice address

2600 FM 1764 Rd Ste 170
La Marque, TX 77568-2828

Phone

(972) 590-8809

Fax

(972) 619-7622

NPI assigned

Jan 25, 2018

Organization subpart

No

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

Authorized official

Name

Faith Gaskins, DIRECTOR

Title

Director of Credentialing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1083112932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734753",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753734753",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 FM 1764 RD STE 170",
            "city": "LA MARQUE",
            "state": "TX",
            "postal_code": "775682828",
            "telephone_number": "972-590-8809",
            "fax_number": "972-619-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULFSIDE DENTAL - LA MARQUE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-25",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789",
        "authorized_official_credential": "DIRECTOR"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in La Marque, TX
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.