Fundentist-North

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

FUNDENTIST-NORTH

Practice address

801 W. Road to Six Flags
Suite 101
Arlington, TX 76012

Phone

(817) 459-1313

Fax

(817) 549-8970

NPI assigned

Aug 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles W. Miller, DDS, MS

Title

Owner

Phone

(817) 478-2300

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Drs Hyde Bailey Miller PTR North Former legal business name

Locations

Practitioners 1

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

• Jerod Wilson Brazeal, D.D.S.

  • Pediatric Dentistry
  • Arlington, TX
  • NPI 1144516311
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1306953906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 LITTLE ROAD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "76016",
            "telephone_number": "817-478-2300",
            "fax_number": "817-478-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W. ROAD TO SIX FLAGS",
            "address_2": "SUITE 101",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "76012",
            "telephone_number": "817-459-1313",
            "fax_number": "817-549-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDENTIST-NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-478-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "9223",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009668701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs Hyde Bailey Miller PTR North",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pediatric Dentistry in Arlington, TX
• Providers in Arlington, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.