NPIMap

Organization Active NPI

River Rock Dental, P.C.

  • General Practice Dentistry
  • Austin, TX
National Provider Identifier
1316213762
Registry record updated Mar 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
23496 Issued in TX
Legal business name
RIVER ROCK DENTAL, P.C.
Practice address
4410 E Riverside Dr
Suite 150
Austin, TX 78741-4799
Phone
(512) 385-4700
Fax
(512) 389-9797
NPI assigned
Mar 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2012

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

Authorized official

Name
Dr. Jackson Booth, DDS
Title
Owner
Phone
(512) 739-9440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 23496 TX Primary

Addresses

Primary practice location

4410 E Riverside Dr
Suite 150
Austin, TX 78741-4799

Mailing address

PO Box 2639
Kyle, TX 78640-1817
Phone (512) 820-6927

Other names 1

  • River Rock Dental Doing business as

National Provider Directory

National Provider Directory

Locations

4410 E Riverside Dr
Ste 150
Austin, TX 78741
Phone (512) 385-4700

NPI Registry JSON

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1316213762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2639",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786401817",
            "telephone_number": "512-820-6927",
            "fax_number": "512-262-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 E RIVERSIDE DR",
            "address_2": "SUITE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787414799",
            "telephone_number": "512-385-4700",
            "fax_number": "512-389-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER ROCK DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-739-9440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "23496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Rock Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; 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.