Cedar Park Periodontics, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

21653 Issued in TX

Legal business name

CEDAR PARK PERIODONTICS, PC

Practice address

209 Denali Pass
Suite a
Cedar Park, TX 78613

Phone

(512) 528-1400

Fax

(512) 528-1466

NPI assigned

Jun 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. David Roy Reeves, DMD, MSNPI 1265494496

Title

President

Phone

(512) 528-1400

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• David Roy Reeves, DMD, MS

  • Periodontics
  • Austin, TX
  • NPI 1265494496
  NPD (past) Authorized official
• Samira M Toloue, DDS, MSD

  • Periodontics
  • Cedar Park, TX
  • NPI 1720344823
  NPD (past)

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295939759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 DENALI PASS",
            "address_2": "SUITE A",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "78613",
            "telephone_number": "512-528-1400",
            "fax_number": "512-528-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 DENALI PASS",
            "address_2": "SUITE A",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "78613",
            "telephone_number": "512-528-1400",
            "fax_number": "512-528-1466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR PARK PERIODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REEVES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-528-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "21653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.