NPIMap

Organization Active NPI

Texas Dental Specialist Practice, PLLC

Doing business as Texas Dental Specialists

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1093457012
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TEXAS DENTAL SPECIALIST PRACTICE, PLLC
Doing business as
Texas Dental Specialists
Practice address
17230 Autry Pond Rd Ste 115
San Antonio, TX 78247-2097
Phone
(210) 396-7667
NPI assigned
Apr 11, 2022
Organization subpart
Yes
Parent organization
TEXAS DENTAL SPECIALIST PRACTICE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Gregory Kostelac
Title
Data Analyst
Phone
(719) 372-5605

Specialties & licenses 1

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

Addresses

Primary practice location

17230 Autry Pond Rd Ste 115
San Antonio, TX 78247-2097

Mailing address

6110 Barnes Rd
Colorado Springs, CO 80922-2600

Other names 1

  • Texas Dental Specialists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Texas Dental Specialist Practice PLLC12 organizations share this tax ID, including this one
Part of
Texas Dental Specialist Practice PLLC

Other organizations with this tax ID 11

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

Locations

17230 Autry Pond Rd
Ste 115
San Antonio, TX 78247
Phone (210) 396-7667

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1093457012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6110 BARNES RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809222600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17230 AUTRY POND RD STE 115",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782472097",
            "telephone_number": "210-396-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS DENTAL SPECIALIST PRACTICE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEXAS DENTAL SPECIALIST PRACTICE, PLLC",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "KOSTELAC",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "DATA ANALYST",
        "authorized_official_telephone_number": "719-372-5605"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Texas Dental Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

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