NPIMap

Organization Active NPI

My Local Texas Dental Practice, PLLC

Doing business as Enhance Dental

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1215697073
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Doing business as
Enhance Dental
Practice address
17230 Autry Pond Rd Ste 115
San Antonio, TX 78247-2097
Phone
(210) 396-7667
NPI assigned
Dec 21, 2021
Last updated
Dec 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Gregory Kostelac
Title
Credentialing Specialist
Phone
(719) 372-5605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

17230 Autry Pond Rd Ste 115
San Antonio, TX 78247-2097

Mailing address

6110 Barnes Rd
Colorado Springs, CO 80922-2600

Other names 1

  • Enhance Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
My Local Texas Dental Practice PLLC16 organizations share this tax ID, including this one
Part of
My Local Texas Dental Practice PLLC

Other organizations with this tax ID 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 1

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": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1215697073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6110 BARNES RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809222600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17230 AUTRY POND RD STE 115",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782472097",
            "telephone_number": "210-396-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY LOCAL TEXAS DENTAL PRACTICE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MY LOCAL TEXAS DENTAL PRACTICE, PLLC",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "KOSTELAC",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "719-372-5605"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enhance Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.