NPIMap

Organization Active NPI

Larry W. Treadaway, D.D.S., Inc.

  • General Practice Dentistry
  • Ennis, TX
National Provider Identifier
1225196264
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12249 Issued in TX
Legal business name
LARRY W. TREADAWAY, D.D.S., INC.
Practice address
504 S Clay St
Ennis, TX 75119-4551
Phone
(972) 875-6081
Fax
(972) 875-5043
NPI assigned
Dec 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Larry W Treadaway, D.D.S.NPI 1952564239
Title
Owner
Phone
(972) 875-6081

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12249 TX Primary

Addresses

Primary practice location

504 S Clay St
Ennis, TX 75119-4551

Mailing address

504 S Clay St
Ennis, TX 75119-4551
Phone (972) 875-6081

National Provider Directory

National Provider Directory

Locations

504 S Clay St
Ennis, TX 75119
Phone (972) 875-6081

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225196264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 S CLAY ST",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194551",
            "telephone_number": "972-875-6081",
            "fax_number": "972-875-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 S CLAY ST",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194551",
            "telephone_number": "972-875-6081",
            "fax_number": "972-875-5043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY W. TREADAWAY, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TREADAWAY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-875-6081",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "12249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ennis, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.