NPIMap

Organization Active NPI

Culberson R Boren DDS PA

Doing business as Dentistry For Children

  • Pediatric Dentistry
  • Longview, TX
National Provider Identifier
1215290697
Registry record updated Jun 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
13063 Issued in TX
Legal business name
CULBERSON R BOREN DDS PA
Doing business as
Dentistry For Children
Practice address
705 E Marshall Ave
Medical Plaza III
Longview, TX 75601-5573
Phone
(903) 581-2198
Fax
(903) 581-9571
NPI assigned
Jun 20, 2012
Last updated
Jun 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2012

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

Authorized official

Name
Dr. Culberson Reeves Boren, DDSNPI 1497837587
Title
Owner/ Doctor
Phone
(903) 581-2198

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 13063 TX Primary

Addresses

Primary practice location

705 E Marshall Ave
Medical Plaza III
Longview, TX 75601-5573

Mailing address

7916 S Broadway Ave
Ste150
Tyler, TX 75703-5274
Phone (903) 581-2198

Other names 1

  • Dentistry For Children Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Culberson R Boren DDS2 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

705 E Marshall Ave
Longview, TX 75601
Phone (903) 315-2000

7916 S Broadway Ave
Ste 150
Tyler, TX 75703
Phone (903) 581-2198

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1215290697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7916 S BROADWAY AVE",
            "address_2": "STE150",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035274",
            "telephone_number": "903-581-2198",
            "fax_number": "903-581-9571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 E MARSHALL AVE",
            "address_2": "MEDICAL PLAZA III",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015573",
            "telephone_number": "903-581-2198",
            "fax_number": "903-581-9571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CULBERSON R BOREN DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "CULBERSON",
        "authorized_official_middle_name": "REEVES",
        "authorized_official_title_or_position": "OWNER/ DOCTOR",
        "authorized_official_telephone_number": "903-581-2198",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "13063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentistry For Children",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.