NPIMap

Organization Active NPI

Brazos Valley Dental Group, LLC

  • Dental Clinic/Center
  • College Station, TX
National Provider Identifier
1306557871
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
BRAZOS VALLEY DENTAL GROUP, LLC
Practice address
219 Rock Prairie Rd Ste 100
College Station, TX 77845-8796
Phone
(979) 695-8000
Fax
(979) 314-9702
NPI assigned
Dec 6, 2022
Last updated
Dec 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Authorized official

Name
Dr. Brian S Black, DDSNPI 1891015996
Title
Dentist / Owner
Phone
(979) 695-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

219 Rock Prairie Rd Ste 100
College Station, TX 77845-8796

Mailing address

219 Rock Prairie Rd Ste 100
College Station, TX 77845-8796
Phone (979) 695-8000

Other names 1

  • Brazos Valley Dental Group, LLC Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1670284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1306557871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 ROCK PRAIRIE RD STE 100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458796",
            "telephone_number": "979-695-8000",
            "fax_number": "979-314-9702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 ROCK PRAIRIE RD STE 100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458796",
            "telephone_number": "979-695-8000",
            "fax_number": "979-314-9702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS VALLEY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-06",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DENTIST / OWNER",
        "authorized_official_telephone_number": "979-695-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brazos Valley Dental Group, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.