Grand Prairie Family Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15515 Issued in TX

Legal business name

GRAND PRAIRIE FAMILY DENTAL GROUP

Practice address

2475 W Pioneer Pkwy
Grand Prairie, TX 75051-3527

Phone

(972) 988-0900

Fax

(972) 660-1167

NPI assigned

Jun 9, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Behrooz Khademazad, DDSNPI 1811163892

Title

Owner

Phone

(972) 988-0900

Specialties & licenses 1

Addresses

Other names 1

• Grand Prairie Family Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Behrooz Khademazad, DDS

  • Dentist
  • Grand Prairie, TX
  • NPI 1811163892
  NPD (past) Authorized official
• Ashlyn Renee Atwell, BSRDH

  • Dental Hygienist
  • Grand Prairie, TX
  • NPI 1174330609
  NPD (past)

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244505600000",
    "number": "1194951798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2475 W PIONEER PKWY",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750513527",
            "telephone_number": "972-988-0900",
            "fax_number": "972-660-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 W PIONEER PKWY",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750513527",
            "telephone_number": "972-988-0900",
            "fax_number": "972-660-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRAIRIE FAMILY DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-09",
        "last_updated": "2009-06-09",
        "status": "A",
        "authorized_official_last_name": "KHADEMAZAD",
        "authorized_official_first_name": "BEHROOZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-988-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "15515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Prairie Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen Lynn Graf, OTR
• Annette Graham
• Grand Prairie Advanced Eyecare Inc
• Grand Prairie Desai Dental PLLC
• Grand Prairie Dialysis Center LLC
• Grand Prairie Isd
• Grand Prairie Marvel Dental PLLC
• Grand Prairie Medical Center LLC
• Grand Prairie Modern Dentistry, PC
• Grand Prairie Physician Group LLC

• General Practice Dentistry in Grand Prairie, TX
• Providers in Grand Prairie, 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 Jun 9, 2009; 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.