NPIMap

Organization Active NPI

My Local Texas Dental Practice, PLLC

Doing business as Empire Dental

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1225798085
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
Empire Dental
Practice address
1915 Rogers Rd
San Antonio, TX 78251-4614
Phone
(210) 361-9977
NPI assigned
Dec 21, 2021
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 DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1915 Rogers Rd
San Antonio, TX 78251-4614

Mailing address

6110 Barnes Rd
Colorado Springs, CO 80922-2600

Other names 1

  • Empire 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

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": "1225798085",
    "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": "1915 ROGERS RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514614",
            "telephone_number": "210-361-9977"
        }
    ],
    "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Empire 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.