Active NPI
Abraham Itty, D.M.D
- Pediatric Dentistry
- Dallas, TX
National Provider Identifier
1235577412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- D009332
- Practice address
- 3302 Gaston Ave
Dallas, TX 75246-2013 - Phone
- (214) 828-8131
- Fax
- (214) 874-4562
- NPI assigned
- Jun 10, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D009332 | AZ | Primary |
Addresses
Primary practice location
3302 Gaston Ave
Dallas, TX 75246-2013
Mailing address
3025 Bryan St Apt 2D
Dallas, TX 75204-6175
Phone (480) 221-6640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D009332 | AZ | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444348800000",
"number": "1235577412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3025 BRYAN ST APT 2D",
"city": "DALLAS",
"state": "TX",
"postal_code": "752046175",
"telephone_number": "480-221-6640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3302 GASTON AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752462013",
"telephone_number": "214-828-8131",
"fax_number": "214-874-4562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ITTY",
"first_name": "ABRAHAM",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-10",
"last_updated": "2015-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "AZ",
"license": "D009332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.