NPIMap

Organization Active NPI

South Plains Pediatric Dental Group

  • Pediatric Dentistry
  • Lubbock, TX
National Provider Identifier
1093923211
Registry record updated Dec 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SOUTH PLAINS PEDIATRIC DENTAL GROUP
Practice address
5102 Salem Ave
Lubbock, TX 79414-4036
Phone
(806) 795-9503
Fax
(806) 795-2920
NPI assigned
May 20, 2007
Last updated
Dec 5, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2007

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

Authorized official

Name
Dr. John Johnson, DDS
Title
Partner Owner
Phone
(806) 795-9503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

5102 Salem Ave
Lubbock, TX 79414-4036

Mailing address

5102 Salem Ave
Lubbock, TX 79414-4036
Phone (806) 795-9503

National Provider Directory

National Provider Directory
Tax ID family
South Plains Pediatric Dental Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1179619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1093923211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5102 SALEM AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794144036",
            "telephone_number": "806-795-9503",
            "fax_number": "806-795-2920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5102 SALEM AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794144036",
            "telephone_number": "806-795-9503",
            "fax_number": "806-795-2920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PLAINS PEDIATRIC DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-20",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PARTNER  OWNER",
        "authorized_official_telephone_number": "806-795-9503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; 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.