NPIMap

Organization Active NPI

Amarillo Dental Associates

  • Dentist
  • Amarillo, TX
National Provider Identifier
1356517650
Registry record updated May 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10364 Issued in TX
Legal business name
AMARILLO DENTAL ASSOCIATES
Practice address
4525 Van Winkle
Amarillo, TX 79119
Phone
(806) 355-7463
Fax
(806) 355-6014
NPI assigned
May 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2011

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

Authorized official

Name
Michael D Vaclav, DDS
Title
Partner
Phone
(806) 355-7463

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 10364 TX Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 21834 TX
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 21834 TX

Addresses

Primary practice location

4525 Van Winkle
Amarillo, TX 79119

Mailing address

4525 Van Winkle
Amarillo, TX 79119
Phone (806) 355-7463

Other identifiers 3

IdentifierTypeStateIssuer
1578606901OtherTXRYAN STREET DDS
0095226-01MedicaidTX
1710020177OtherTXMICHAEL VACLAV DDS

Other names 1

  • Michael D Vaclav DDS & Ryan Street DDS Other name

National Provider Directory

National Provider Directory

Locations

4525 Van Winkle Dr
Amarillo, TX 79119
Phone (806) 355-7463

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1356517650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 VAN WINKLE",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "79119",
            "telephone_number": "806-355-7463",
            "fax_number": "806-355-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 VAN WINKLE",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "79119",
            "telephone_number": "806-355-7463",
            "fax_number": "806-355-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMARILLO DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "VACLAV",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "806-355-7463",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "10364",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "21834",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21834",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RYAN STREET DDS",
            "identifier": "1578606901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0095226-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHAEL VACLAV DDS",
            "identifier": "1710020177",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael D Vaclav DDS & Ryan Street DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Amarillo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; 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.