Children'S Dental Depot PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CHILDREN'S DENTAL DEPOT PA

Practice address

833 W Main St
Gun Barrel City, TX 75156-5312

Phone

(903) 686-9992

NPI assigned

Jan 8, 2020

Organization subpart

No

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

Authorized official

Name

Jolie Plagens

Title

Billing and Insurance Coord

Phone

(915) 855-2337

Specialties & licenses 1

Addresses

Other names 1

• Nannis Little Smiles Dentistry For Children PA Former legal business name

Tax ID family

Children'S Dental Depot PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Nannis Little Smiles Dentistry for Children PA

  • Pediatric Dentistry
  • Boerne, TX
  • NPI 1801970579
  NPD tax ID

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1235779109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11165 LA QUINTA PL",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799365221",
            "telephone_number": "915-855-2337",
            "fax_number": "915-503-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 W MAIN ST",
            "city": "GUN BARREL CITY",
            "state": "TX",
            "postal_code": "751565312",
            "telephone_number": "903-686-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTAL DEPOT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "PLAGENS",
        "authorized_official_first_name": "JOLIE",
        "authorized_official_title_or_position": "BILLING AND INSURANCE COORD",
        "authorized_official_telephone_number": "915-855-2337"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nannis Little Smiles Dentistry For Children PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cedar Creek Clinic, LLC
• Cedar Creek Healthcare, PC
• Cedar Creek Wellness Group
• Shawntel Chamberland, PHYSICAL THERAPIST A
• Charles L. Heaton, MD, PA
• Wandy Connolly, DMD
• Charles Derick Cooper, NP
• Leslie Crow
• Douglas W Curran, MD
• CVS Pharmacy Inc

• All providers in Gun Barrel City, TX
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.