Mo Pezeshk, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

34820 Issued in TX

Practice address

1780 Round Rock Ave Ste 100
Round Rock, TX 78681-4069

Phone

(512) 341-7500

NPI assigned

Jul 5, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Familia Dental Racine LLC

  dba Familia Dental

  • Dental Clinic/Center
  • Racine, WI
  • NPI 1962883926
  NPD (past)

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

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1164787230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1780 ROUND ROCK AVE STE 100",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814069",
            "telephone_number": "512-341-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 ROUND ROCK AVE STE 100",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814069",
            "telephone_number": "512-341-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZESHK",
        "first_name": "MO",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-05",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029106",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001461",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "34820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genita Petralli, AMNA
• Erika Amethyst Petre, BCBA, LBA
• Edward Wayne Petrik, M.D.
• Madison Petrmichl, BCBA
• Bonny Benjamin Petty, PA-C
• Amber Pfertner
• Christie Minhtrang Pham, DO
• Hali Pham
• Hiep Duy Pham
• Joseph Cuong Pham, RPH

• Dentist in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.