NPIMap

Organization Active NPI

Children's Dentistry of Kyle

Doing business as Children's Dentistry of Gonzales

  • Pediatric Dentistry
  • Gonzales, TX
National Provider Identifier
1265734594
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
22616 Issued in TX
Legal business name
CHILDREN'S DENTISTRY OF KYLE
Doing business as
Children's Dentistry of Gonzales
Practice address
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone
(512) 268-4400
Fax
(512) 268-4402
NPI assigned
Nov 18, 2010
Last updated
Nov 18, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S DENTISTRY OF KYLEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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

Authorized official

Name
Dr. Jeremy Wittich, DDS
Title
Owner/Provider
Phone
(512) 268-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 22616 TX Primary

Addresses

Primary practice location

1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311

Mailing address

1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone (512) 268-4400

Other names 1

  • Children's Dentistry of Gonzales Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Children's Dentistry of Kyle2 organizations share this tax ID, including this one
Part of
Children's Dentistry of Kyle

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1265734594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 N SARAH DEWITT DR",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786293311",
            "telephone_number": "512-268-4400",
            "fax_number": "512-268-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N SARAH DEWITT DR",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786293311",
            "telephone_number": "512-268-4400",
            "fax_number": "512-268-4402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTISTRY OF KYLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S DENTISTRY OF KYLE",
        "enumeration_date": "2010-11-18",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "WITTICH",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "512-268-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "22616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Dentistry of Gonzales",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gonzales, TX

Sources for this page

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