Active NPI
Nathaniel Phen, DMD
- General Practice Dentistry
- Killeen, TX
National Provider Identifier
1306332325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34291
- Practice address
- 2202 S W S Young Dr Ste 102
Killeen, TX 76543-5318 - Phone
- (254) 523-0934
- NPI assigned
- Jul 2, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34291 | TX | Primary |
Addresses
Primary practice location
2202 S W S Young Dr Ste 102
Killeen, TX 76543-5318
Mailing address
1400 Westinghouse Rd # 1213
Georgetown, TX 78626-2174
Phone (863) 370-5061
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201211001951 | TX | Order and Referring Only - Dentist | 7214349414 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34291 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530489600000",
"number": "1306332325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 WESTINGHOUSE RD # 1213",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786262174",
"telephone_number": "863-370-5061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2202 S W S YOUNG DR STE 102",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765435318",
"telephone_number": "254-523-0934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHEN",
"first_name": "NATHANIEL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-02",
"last_updated": "2018-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "34291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Killeen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.