Active NPI
Carlos Sevilla
- Prosthodontics
- Dallas, TX
National Provider Identifier
1255755781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 29240
- Practice address
- 3302 Gaston Ave
Dallas, TX 75246-2013 - Phone
- (214) 245-9409
- NPI assigned
- Feb 4, 2014
- Last updated
- Feb 4, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 29240 | TX | Primary |
Addresses
Primary practice location
3302 Gaston Ave
Dallas, TX 75246-2013
Mailing address
5657 Amesbury Dr Apt 1912
Dallas, TX 75206-3077
Phone (214) 245-9409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29240 | TX | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391472000000",
"number": "1255755781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5657 AMESBURY DR APT 1912",
"city": "DALLAS",
"state": "TX",
"postal_code": "752063077",
"telephone_number": "214-245-9409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3302 GASTON AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752462013",
"telephone_number": "214-245-9409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEVILLA",
"first_name": "CARLOS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-04",
"last_updated": "2014-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "TX",
"license": "29240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.