Individual provider Active NPI

Kasra Dabeshlim, DMD

  • Endodontics
  • Plano, TX
National Provider Identifier
1184199390
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
30.027447 Issued in OH
Practice address
101 W Spring Creek Pkwy Ste 732
Plano, TX 75023-4631
Phone
(972) 517-4282
NPI assigned
Oct 4, 2018
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 11100 KY
Dentist 122300000X 30.027447 OH
Dentist 122300000X 34669 TX
Endodontics 1223E0200X 34669 TX
Endodontics 1223E0200X 11100 KY
Endodontics 1223E0200X 30.027447 OH Primary

Addresses

Primary practice location

101 W Spring Creek Pkwy Ste 732
Plano, TX 75023-4631

Mailing address

101 W Spring Creek Pkwy Ste 732
Plano, TX 75023-4631
Phone (000) 000-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250731003794 OH Order and Referring Only - DentistPractitioner - Dentist 1153839287

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34669TXMDDentist
11100KYMDEndodontist
30.027447OHMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Spring Creek Dental Group PLLC Dentist CurrentSince Jun 21, 2022 Accepting new patients
Creek 75 Dental Group PC PastSince Oct 24, 2021 Accepting new patients

Locations

101 W Spring Creek Pkwy
Ste 732
Plano, TX 75023
Phone (214) 415-9096

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1184199390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W SPRING CREEK PKWY STE 732",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750234631",
            "telephone_number": "000-000-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W SPRING CREEK PKWY STE 732",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750234631",
            "telephone_number": "972-517-4282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DABESHLIM",
        "first_name": "KASRA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-04",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "11100",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.027447",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "34669",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "34669",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "KY",
            "license": "11100",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OH",
            "license": "30.027447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.