Broad Park Family Dentistry

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

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dax Michael Sinn, DDS

Title

Owner

Phone

(817) 473-6857

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shanna Howze, DDS

  • General Practice Dentistry
  • Mansfield, TX
  • NPI 1043819451
  NPD (past)
• Jeremy I Rudd, D.M.D.

  • General Practice Dentistry
  • Mansfield, TX
  • NPI 1073602645
  NPD (past)
• Alysa Brooke Sadkin, DMD

  • General Practice Dentistry
  • Mansfield, TX
  • NPI 1518522754
  NPD (past)

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

{
    "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": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "D21075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremiah Brewer, DO
• Brighter Light Behavioral Health Services PLLC
• Courtney Briney
• Sade Briscoe, FNP-C
• Broad Park Dental PA
• Broad Park Imaging, LLC
• Nicolas Austin Broadway
• Donche Tromaine Brock, NP
• Patricia Charlene Laurie Brock, D.O.
• Sydney Brock

• General Practice Dentistry in Mansfield, TX
• Providers in Mansfield, TX by specialty
• General Practice Dentistry in Texas

• 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.