NPIMap

Organization Active NPI

Galena Park Dental

  • Dentist
  • Galena Park, TX
National Provider Identifier
1205019478
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22483 Issued in TX
Legal business name
GALENA PARK DENTAL
Practice address
1705 Clinton Dr
Galena Park, TX 77547-3224
Phone
(713) 672-4479
NPI assigned
Dec 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Authorized official

Name
Mary N Phan
Title
Doctor
Phone
(713) 672-4779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 22483 TX Primary

Addresses

Primary practice location

1705 Clinton Dr
Galena Park, TX 77547-3224

Mailing address

1705 Clinton Dr
Galena Park, TX 77547-3224

Other identifiers 1

IdentifierTypeStateIssuer
178688101MedicaidTX

Other names 1

  • GALENA PARK DENTAL Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Galena Park Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1705 Clinton Dr
Galena Park, TX 77547
Phone (713) 672-4779

NPI Registry JSON

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1205019478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 CLINTON DR",
            "city": "GALENA PARK",
            "state": "TX",
            "postal_code": "775473224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CLINTON DR",
            "city": "GALENA PARK",
            "state": "TX",
            "postal_code": "775473224",
            "telephone_number": "713-672-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALENA PARK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "713-672-4779"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "22483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178688101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GALENA PARK DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galena Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; 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.