Restore Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

22213 Issued in TX

Legal business name

RESTORE DENTAL PLLC

Practice address

3108 W State Highway 22
Corsicana, TX 75110-2435

Phone

(903) 257-8815

Fax

(903) 900-4184

NPI assigned

Jan 12, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Mahesh B. Gondi, DMD

Title

President

Phone

(903) 257-8815

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1421020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452729600000",
    "number": "1104215367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3108 W STATE HIGHWAY 22",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751102435",
            "telephone_number": "903-257-8815",
            "fax_number": "903-900-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3108 W STATE HIGHWAY 22",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751102435",
            "telephone_number": "903-257-8815",
            "fax_number": "903-900-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-12",
        "last_updated": "2016-01-14",
        "status": "A",
        "authorized_official_last_name": "GONDI",
        "authorized_official_first_name": "MAHESH",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-257-8815",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22213",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "22213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1306909080",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trivikram Reddy
• Demetria Reed, DPT
• Regional Employee Assistance Program
• Regional Employee Assistance Program Inc
• Regional Employee Assistance Program Inc
• Ida Pearl Reynolds, P.N.P.
• Johanna Rhodes, OTR
• Richard P Harper, DDS, PHD, PA
• Christopher Blake Richardson, D.D.S.
• Mario P. Ridad

• Dental Clinic/Center in Corsicana, TX
• Providers in Corsicana, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; 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.