La Costa Dental of Leopard PA

Primary specialty

DentistTaxonomy code 122300000X

License

22334 Issued in TX

Legal business name

LA COSTA DENTAL OF LEOPARD PA

Practice address

3505 Leopard St
Corpus Christi, TX 78408-3203

Phone

(817) 531-3500

Fax

(817) 531-3501

NPI assigned

Apr 2, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Tien Dinh Phan, DMD

Title

Dentist

Phone

(817) 531-3500

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1336567882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8150 SPRINGWOOD DR # 150B",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750635810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 LEOPARD ST",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784083203",
            "telephone_number": "817-531-3500",
            "fax_number": "817-531-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA COSTA DENTAL OF LEOPARD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-02",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "TIEN",
        "authorized_official_middle_name": "DINH",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "817-531-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "22334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.