NPIMap

Organization Active NPI

Creekwood Dental Arts, PLLC

  • Dental Clinic/Center
  • Waco, TX
National Provider Identifier
1235735218
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
CREEKWOOD DENTAL ARTS, PLLC
Practice address
7911 Woodway Dr
Waco, TX 76712-3866
Phone
(254) 772-3632
Fax
(254) 772-7856
NPI assigned
Dec 7, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Dr. Austin Revvie Green, DDSNPI 1194254714
Title
Dentist
Phone
(254) 772-3632

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

7911 Woodway Dr
Waco, TX 76712-3866

Mailing address

7911 Woodway Dr
Waco, TX 76712-3866
Phone (254) 772-3632

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address DrGreen@creekwooddentalarts.com

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1235735218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7911 WOODWAY DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123866",
            "telephone_number": "254-772-3632",
            "fax_number": "254-772-7856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7911 WOODWAY DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123866",
            "telephone_number": "254-772-3632",
            "fax_number": "254-772-7856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKWOOD DENTAL ARTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_middle_name": "REVVIE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "254-772-3632",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DrGreen@creekwooddentalarts.com",
            "affiliation": "N",
            "address_1": "7911 Woodway Dr",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767123866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.