NPIMap

Organization Active NPI

M M Orthodontics PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • San Antonio, TX
National Provider Identifier
1255348926
Registry record updated May 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
20402 Issued in TX
Legal business name
M M ORTHODONTICS PA
Practice address
4422 De Zavala Rd
San Antonio, TX 78249-2013
Phone
(210) 696-3001
Fax
(210) 764-1989
NPI assigned
Aug 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2010

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

Authorized official

Name
Dr. Diana T Malone, D.D.S.,M.S.
Title
Orthodontist
Phone
(210) 696-3001

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 20402 TX Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 21086 TX

Addresses

Primary practice location

4422 De Zavala Rd
San Antonio, TX 78249-2013

Mailing address

4422 De Zavala Rd
San Antonio, TX 78249-2013
Phone (210) 696-3001

Other identifiers 6

IdentifierTypeStateIssuer
1312131OtherTXUNITED CONCORDIA DENTAL
174951703MedicaidTX
142539903MedicaidTX
174952503MedicaidTX
0014940OtherTXFACILITY NUMBER
142539908MedicaidTX

Other names 1

  • M & M Orthodontics, PA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
M M Orthodontics PA3 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.

Locations

4422 De Zavala Rd
San Antonio, TX 78249
Phone (210) 572-2394

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274745600000",
    "number": "1255348926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4422 DE ZAVALA RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782492013",
            "telephone_number": "210-696-3001",
            "fax_number": "210-764-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4422 DE ZAVALA RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782492013",
            "telephone_number": "210-696-3001",
            "fax_number": "210-764-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M M ORTHODONTICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2010-05-25",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "210-696-3001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.,M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "20402",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "21086",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA DENTAL",
            "identifier": "1312131",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174951703",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142539903",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174952503",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY NUMBER",
            "identifier": "0014940",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142539908",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M & M Orthodontics, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2010; 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.