Pasadena Dental & Orthodontics PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

23066 Issued in TX

Legal business name

PASADENA DENTAL & ORTHODONTICS PLLC

Practice address

1611 Spencer Hwy
C & D1
South Houston, TX 77587-3772

Phone

(817) 529-8151

Fax

(817) 529-8156

NPI assigned

Apr 30, 2015

Organization subpart

No

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

Authorized official

Name

Raffy Kouyoumdjian

Title

Owner

Phone

(817) 529-8151

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1316324155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 SPENCER HWY",
            "address_2": "C & D1",
            "city": "SOUTH HOUSTON",
            "state": "TX",
            "postal_code": "775873772",
            "telephone_number": "817-529-8151",
            "fax_number": "817-529-8156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 SPENCER HWY",
            "address_2": "C & D1",
            "city": "SOUTH HOUSTON",
            "state": "TX",
            "postal_code": "775873772",
            "telephone_number": "817-529-8151",
            "fax_number": "817-529-8156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASADENA DENTAL & ORTHODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "KOUYOUMDJIAN",
        "authorized_official_first_name": "RAFFY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-529-8151"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "23066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419510",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419513",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419515",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419514",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419517",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419511",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419516",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in South Houston, TX
• Providers in South Houston, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; 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.