Broad Park Dental PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22486 Issued in TX

Legal business name

BROAD PARK DENTAL PA

Practice address

1750 E Broad St
Mansfield, TX 76063-3400

Phone

(817) 473-6857

Fax

(817) 473-3256

NPI assigned

May 26, 2009

Last updated

May 26, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy Israel Rudd, DMDNPI 1073602645

Title

Owner

Phone

(817) 473-6857

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeremy I Rudd, D.M.D.

  • General Practice Dentistry
  • Mansfield, TX
  • NPI 1073602645
  NPD (past) Authorized official
• Shanna Howze, DDS

  • General Practice Dentistry
  • Mansfield, TX
  • NPI 1043819451
  NPD (past)
• Alysa Brooke Sadkin, DMD

  • General Practice Dentistry
  • Mansfield, TX
  • NPI 1518522754
  NPD (past)

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1083849707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E BROAD ST",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633400",
            "telephone_number": "817-473-6857",
            "fax_number": "817-473-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E BROAD ST",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633400",
            "telephone_number": "817-473-6857",
            "fax_number": "817-473-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD PARK DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-26",
        "last_updated": "2009-05-26",
        "status": "A",
        "authorized_official_last_name": "RUDD",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "ISRAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-473-6857",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hailey Brewer
• Jeremiah Brewer, DO
• Brighter Light Behavioral Health Services PLLC
• Courtney Briney
• Sade Briscoe, FNP-C
• Broad Park Family Dentistry
• Broad Park Imaging, LLC
• Nicolas Austin Broadway
• Donche Tromaine Brock, NP
• Patricia Charlene Laurie Brock, D.O.

• General Practice Dentistry in Mansfield, TX
• Providers in Mansfield, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; 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.