NPIMap

Organization Active NPI

Pediatric Dentistry of Sherman, PA

  • Pediatric Dentistry
  • Princeton, TX
National Provider Identifier
1245516574
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
23222 Issued in TX
Legal business name
PEDIATRIC DENTISTRY OF SHERMAN, PA
Doing business as
Pediatric Dentistry of Princeton
Practice address
275 W Princeton Dr
Suite 100
Princeton, TX 75407-9602
Phone
(972) 736-1000
Fax
(972) 736-1002
NPI assigned
Nov 1, 2011
Organization subpart
Yes
Parent organization
PEDIATRIC DENTISTRY OF SHERMAN, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Authorized official

Name
Dr. Robert Williamson, D.D.S., M.S.
Title
Director/Owner
Phone
(972) 736-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 23222 TX Primary

Addresses

Primary practice location

275 W Princeton Dr
Suite 100
Princeton, TX 75407-9602

Mailing address

275 W Princeton Dr
Suite 100
Princeton, TX 75407-9602
Phone (972) 736-1000

Other identifiers 1

IdentifierTypeStateIssuer
1316103443MedicaidTX

Other names 1

  • Pediatric Dentistry of Princeton Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Dentistry of Sherman PA2 organizations share this tax ID, including this one
Part of
Pediatric Dentistry of Sherman PA

Other organizations with this tax ID 1

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

Locations

275 W Princeton Dr
Ste 100
Princeton, TX 75407
Phone (972) 736-1000

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1245516574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 W PRINCETON DR",
            "address_2": "SUITE 100",
            "city": "PRINCETON",
            "state": "TX",
            "postal_code": "754079602",
            "telephone_number": "972-736-1000",
            "fax_number": "972-736-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W PRINCETON DR",
            "address_2": "SUITE 100",
            "city": "PRINCETON",
            "state": "TX",
            "postal_code": "754079602",
            "telephone_number": "972-736-1000",
            "fax_number": "972-736-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF SHERMAN, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC DENTISTRY OF SHERMAN, PA",
        "enumeration_date": "2011-11-01",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "972-736-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "23222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316103443",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry of Princeton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.