8901 Tehama Ridge Pkwy PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

8901 TEHAMA RIDGE PKWY PLLC

Doing business as

Fresh Smiles of Fort Worth Alliance

Practice address

8901 Tehama Ridge Pkwy Ste 119
Fort Worth, TX 76177-2032

Phone

(214) 317-4039

NPI assigned

Oct 5, 2022

Organization subpart

No

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

Authorized official

Name

Gunjan Dhir, DDS

Title

Owner

Phone

(817) 809-4860

Specialties & licenses 1

Addresses

Other names 1

• Fresh Smiles of Fort Worth Alliance Doing business as

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prem Patel, DMD MD

  • Surgery Physician
  • Arlington, TX
  • NPI 1306164066
  NPD (past)

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1265157978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 E RANDOL MILL RD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760116349",
            "telephone_number": "817-809-4860",
            "fax_number": "682-626-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 TEHAMA RIDGE PKWY STE 119",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761772032",
            "telephone_number": "214-317-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "8901 TEHAMA RIDGE PKWY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "DHIR",
        "authorized_official_first_name": "GUNJAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-809-4860",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@altiusdental.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "8901 Tehama Ridge Pkwy Ste 119",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761772032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Fresh Smiles of Fort Worth Alliance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fresh Smiles of Fort Worth Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Fort Worth, TX
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; 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.