NPIMap

Organization Active NPI

Dezavala Family Dental, PLLC

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1376085712
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
26540 Issued in TX
Legal business name
DEZAVALA FAMILY DENTAL, PLLC
Practice address
5563 De Zavala Rd
160
San Antonio, TX 78249-1734
Phone
(210) 696-7885
NPI assigned
Nov 16, 2016
Last updated
Nov 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Dr. Andia Nadimi, DMD
Title
President
Phone
(210) 696-7885

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 26540 TX Primary

Addresses

Primary practice location

5563 De Zavala Rd
160
San Antonio, TX 78249-1734

Mailing address

5563 De Zavala Rd Ste 160
San Antonio, TX 78249-1738
Phone (210) 696-7885

Other identifiers 1

IdentifierTypeStateIssuer
28162330MedicaidTX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1479254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1376085712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5563 DE ZAVALA RD STE 160",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782491738",
            "telephone_number": "210-696-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5563 DE ZAVALA RD",
            "address_2": "160",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782491734",
            "telephone_number": "210-696-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEZAVALA FAMILY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-16",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "NADIMI",
        "authorized_official_first_name": "ANDIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-696-7885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "26540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28162330",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; 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.