NPIMap

Organization Active NPI

Tri Dental, LLC

  • General Practice Dentistry
  • Rio Rancho, NM
National Provider Identifier
1124779210
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TRI DENTAL, LLC
Practice address
2345 Southern Blvd SE Ste B1
Rio Rancho, NM 87124-3761
Phone
(505) 892-0111
NPI assigned
Jan 11, 2022
Organization subpart
Yes
Parent organization
TRI DENTAL, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Brenton Mason, DMDNPI 1336138031
Title
Member
Phone
(505) 301-4267

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2345 Southern Blvd SE Ste B1
Rio Rancho, NM 87124-3761

Mailing address

2345 Southern Blvd SE Ste B1
Rio Rancho, NM 87124-3761
Phone (505) 892-0111

Other identifiers 1

IdentifierTypeStateIssuer
50284282MedicaidNM

Other names 1

  • Sonrisa Family Dental- Rio Rancho Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL sonrisadentalgroup.com Direct Tri Dental, LLC

National Provider Directory

National Provider Directory
Tax ID family
Tri Dental LLC2 organizations share this tax ID, including this one
Part of
Tri Dental LLC

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

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": "1641859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1124779210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 SOUTHERN BLVD SE STE B1",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871243761",
            "telephone_number": "505-892-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 SOUTHERN BLVD SE STE B1",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871243761",
            "telephone_number": "505-892-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI DENTAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI DENTAL, LLC",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "BRENTON",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "505-301-4267",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50284282",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "sonrisadentalgroup.com",
            "affiliation": "Y",
            "endpointDescription": "Webpage",
            "affiliationName": "Tri Dental, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Webpage/ email",
            "address_1": "2345 Southern Blvd SE Ste B1",
            "city": "Rio Rancho",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871243761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sonrisa Family Dental- Rio Rancho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rio Rancho, NM

Sources for this page

  • 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.