NPIMap

Organization Active NPI

Idental

  • Dentist
  • Dallas, TX
National Provider Identifier
1265830947
Registry record updated Sep 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19711 Issued in TX
Legal business name
IDENTAL
Practice address
14902 Preston Rd
401
Dallas, TX 75254-9191
Phone
(916) 425-4172
NPI assigned
Dec 12, 2014
Last updated
Sep 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2016

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

Authorized official

Name
Hossain DezhamNPI 1710166772
Title
Dentist/ Owner
Phone
(916) 716-8311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 19711 TX Primary

Addresses

Primary practice location

14902 Preston Rd
401
Dallas, TX 75254-9191

Mailing address

14205 Hughes LN
Dallas, TX 75254-8655

Other identifiers 1

IdentifierTypeStateIssuer
187702903MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Idental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1418342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1265830947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14205 HUGHES LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752548655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14902 PRESTON RD",
            "address_2": "401",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752549191",
            "telephone_number": "916-425-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-12",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "DEZHAM",
        "authorized_official_first_name": "HOSSAIN",
        "authorized_official_title_or_position": "DENTIST/ OWNER",
        "authorized_official_telephone_number": "916-716-8311"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "19711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187702903",
            "state": "TX"
        }
    ],
    "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 Sep 20, 2016; 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.