Yonatan Pevzner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

34863 Issued in TX

Practice address

1455 E Whitestone Blvd Ste 127
Cedar Park, TX 78613-5031

Phone

(512) 259-7171

NPI assigned

Mar 6, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pevzner DDS PLLC

  • Dental Clinic/Center
  • Austin, TX
  • NPI 1386239762
  NPD (past) Authorized official
• Cedar Park Modern Dentistry, PC

  dba Cedar Park Modern Dentistry

  • General Practice Dentistry
  • Cedar Park, TX
  • NPI 1205144920
  NPD (past)

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1376001545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 E WHITESTONE BLVD STE 127",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786135031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 E WHITESTONE BLVD STE 127",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786135031",
            "telephone_number": "512-259-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEVZNER",
        "first_name": "YONATAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "34863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Callie Nicole Peters, DC
• Shari Lynette Petersen, APRN, FNP-BC
• Keerti Kirun Peterson, M.D.
• Tabitha Peterson
• Adelina Petrova, DENTIST D.M.D.
• Hong-Ngoc Pham
• Toai Cong Pham, D.D.S.
• Doan Phan, LCSW
• Quynh-Nhu Tan Phan, D.D.S.
• Phoenix Rising Behavioral Services LLC

• General Practice Dentistry in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.