SE Professional

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SE PROFESSIONAL

Practice address

5858 W Main St
Frisco, TX 75033-4193

Phone

(972) 377-4477

NPI assigned

May 12, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jared Bruggeman

Title

Dentist

Phone

(817) 912-2982

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399852800000",
    "number": "1174934236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 S MAIN ST",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517533",
            "telephone_number": "972-377-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5858 W MAIN ST",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750334193",
            "telephone_number": "972-377-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SE PROFESSIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-12",
        "last_updated": "2014-05-12",
        "status": "A",
        "authorized_official_last_name": "BRUGGEMAN",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "817-912-2982",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; 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.