NPIMap

Organization Active NPI

Southpark Smiles, PC

  • Dentist
  • Austin, TX
National Provider Identifier
1215259684
Registry record updated Feb 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
23496 Issued in TX
Legal business name
SOUTHPARK SMILES, PC
Practice address
4410 E Riverside Dr
Suite 150
Austin, TX 78741-4799
Phone
(512) 385-4700
NPI assigned
Feb 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2010

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

Authorized official

Name
Dr. Jackson R Booth, DDS
Title
President
Phone
(512) 282-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 23496 TX Primary

Addresses

Primary practice location

4410 E Riverside Dr
Suite 150
Austin, TX 78741-4799

Mailing address

9500 South Ih 35
Suite E 400
Austin, TX 78748-1990
Phone (512) 282-7200

Other names 1

  • Eastside Smiles Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eastside Smiles2 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.

NPI Registry JSON

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

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267056000000",
    "number": "1215259684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 SOUTH IH 35",
            "address_2": "SUITE E 400",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787481990",
            "telephone_number": "512-282-7200",
            "fax_number": "512-282-7204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 E RIVERSIDE DR",
            "address_2": "SUITE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787414799",
            "telephone_number": "512-385-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK SMILES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-25",
        "last_updated": "2010-02-25",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-282-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "23496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2010; 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.