Dezavala Dental and Braces PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DEZAVALA DENTAL AND BRACES PLLC

Practice address

4519 Dezavala Road
San Antonio, TX 78249

Phone

(210) 690-9221

NPI assigned

Sep 8, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Joel Olmos, DDS

Title

Owner/ Doctor

Phone

(512) 268-3384

Specialties & licenses 1

Addresses

Other names 1

• Dezavala Dental and Braces Doing business as

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

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1194494708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4519 DEZAVALA ROAD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78249",
            "telephone_number": "210-690-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4519 DEZAVALA ROAD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78249",
            "telephone_number": "210-690-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEZAVALA DENTAL AND BRACES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-08",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "OLMOS",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "OWNER/ DOCTOR",
        "authorized_official_telephone_number": "512-268-3384",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dezavala Dental and Braces",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dezavala Dental and Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nikul Dhaduk
• Prit Mahesh Dhagat, DO

• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, 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 Nov 16, 2021; 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.