NPIMap

Organization Active NPI

Broad Park Family Dentistry

  • General Practice Dentistry
  • Mansfield, TX
National Provider Identifier
1154440089
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D21075 Issued in TX
Legal business name
BROAD PARK FAMILY DENTISTRY
Practice address
1750 E Broad St
Mansfield, TX 76063-3400
Phone
(817) 473-6857
NPI assigned
Mar 29, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dax Michael Sinn, DDS
Title
Owner
Phone
(817) 473-6857

Practitioners 3

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

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D21075 TX Primary

Addresses

NPPES NPI Registry

Primary practice location

1750 E Broad St
Mansfield, TX 76063-3400

Mailing address

1750 E Broad St
Mansfield, TX 76063-3400
Phone (817) 473-6857

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154440089",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD PARK FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SINN",
        "authorized_official_first_name": "DAX",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-473-6857",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "D21075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.