Pflugerville Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

20343 Issued in TX

Legal business name

PFLUGERVILLE PERIODONTICS

Practice address

2911 A W Grimes Blvd
Pflugerville, TX 78660-5458

Phone

(512) 990-8550

NPI assigned

Oct 18, 2017

Organization subpart

No

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

Authorized official

Name

Jonathan Callia, DDS, MS

Title

Shareholder

Phone

(512) 990-8550

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1255842159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 A W GRIMES BLVD",
            "city": "PFLUGERVILLE",
            "state": "TX",
            "postal_code": "786605458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 A W GRIMES BLVD",
            "city": "PFLUGERVILLE",
            "state": "TX",
            "postal_code": "786605458",
            "telephone_number": "512-990-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PFLUGERVILLE PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-18",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "CALLIA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "SHAREHOLDER",
        "authorized_official_telephone_number": "512-990-8550",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "20343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pflugerville Integrated Medical PLLC
• Pflugerville Isd
• Pflugerville Medical Center
• Pflugerville Modern Dentistry PC
• Pflugerville Orthodontics PA
• Pflugerville Vision Care PA
• Pflugerville Wellness Center PLLC
• Ngocanh Pham, OD
• Kelly Phuong Phan, O.D.
• Jennifer Leigh Phillips, MS, CCC-SLP

• Periodontics in Pflugerville, TX
• Providers in Pflugerville, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.