Time Square Dental Group

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

TIME SQUARE DENTAL GROUP

Practice address

4450 E Sam Houston Pkwy S
Suite H2
Pasadena, TX 77505-3950

Phone

(713) 910-7779

Fax

(713) 910-7760

NPI assigned

Jan 19, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Razan Daccak, D.D.S.

Title

Owner

Phone

(713) 910-7779

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263859200000",
    "number": "1225369077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 460182",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770568182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 E SAM HOUSTON PKWY S",
            "address_2": "SUITE H2",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775053950",
            "telephone_number": "713-910-7779",
            "fax_number": "713-910-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIME SQUARE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "last_updated": "2010-01-19",
        "status": "A",
        "authorized_official_last_name": "DACCAK",
        "authorized_official_first_name": "RAZAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-910-7779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "190182901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Davi Thomas, DPT
• Alan Arthur Thompson, D.C.
• Lori A Thompson, OTR
• Elizabeth Thottukandathil
• Ken Lee Thrasher, MD
• Drew Alan Tiner, RPH
• TMH Physician Associates PLLC
• Regina M. Tobar, FNP-C
• Today'S Vision Sharpstown Court, PA
• Timothy Jo Toguchi, FNP - BC

• Periodontics in Pasadena, TX
• Providers in Pasadena, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.