NPIMap

Organization Active NPI

FWB Dental

  • General Practice Dentistry
  • Houston, TX
National Provider Identifier
1245770148
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30466 Issued in TX
Legal business name
FWB DENTAL
Practice address
1684 Willowbrook Mall
Houston, TX 77070-6027
Phone
(281) 955-5558
Fax
(281) 955-8763
NPI assigned
Feb 27, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Authorized official

Name
Dr. Vlada Matytsin, DDSNPI 1003964339
Title
Owner/Dentist
Phone
(281) 955-5558

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 30466 TX Primary

Addresses

Primary practice location

1684 Willowbrook Mall
Houston, TX 77070-6027

Mailing address

1684 Willowbrook Mall
Houston, TX 77070-6027
Phone (281) 955-5558

Other names 1

  • Willowbrook Mall Dental Other name

National Provider Directory

National Provider Directory
Tax ID family
Baybrook Mall Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1245770148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1684 WILLOWBROOK MALL",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770706027",
            "telephone_number": "281-955-5558",
            "fax_number": "281-955-8763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 WILLOWBROOK MALL",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770706027",
            "telephone_number": "281-955-5558",
            "fax_number": "281-955-8763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FWB DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "MATYTSIN",
        "authorized_official_first_name": "VLADA",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "281-955-5558",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willowbrook Mall Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; 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.