NPIMap

Organization Active NPI

River Rock - Airport, P.C.

Doing business as River Rock Dental

  • General Practice Dentistry
  • Austin, TX
National Provider Identifier
1356616825
Registry record updated Mar 17, 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 - AIRPORT, P.C.
Doing business as
River Rock Dental
Practice address
1192 Airport Blvd
Suite B
Austin, TX 78702-3176
Phone
(512) 820-6927
Fax
(512) 262-7074
NPI assigned
Mar 17, 2012
Last updated
Mar 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2012

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

Authorized official

Name
Dr. Jackson Booth, DDSNPI 1891987368
Title
Owner
Phone
(512) 739-9440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1192 Airport Blvd
Suite B
Austin, TX 78702-3176

Mailing address

PO Box 2638
Kyle, TX 78640-1817
Phone (512) 385-4700

Other names 1

  • River Rock Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1192 Airport Blvd
Ste B
Austin, TX 78702
Phone (512) 820-6927

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1331942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331942400000",
    "number": "1356616825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2638",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786401817",
            "telephone_number": "512-385-4700",
            "fax_number": "512-389-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1192 AIRPORT BLVD",
            "address_2": "SUITE B",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787023176",
            "telephone_number": "512-820-6927",
            "fax_number": "512-262-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER ROCK - AIRPORT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-17",
        "last_updated": "2012-03-17",
        "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 17, 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.