Active NPI
Jon T Koblensvik, DDS
- General Practice Dentistry
- Carrollton, TX
National Provider Identifier
1386653939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14206
- Practice address
- 1735 Keller Springs Rd
Suite 204
Carrollton, TX 75006-2962 - Phone
- (972) 245-3455
- Fax
- (972) 242-1686
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14206 | TX | Primary |
Addresses
Primary practice location
1735 Keller Springs Rd
Suite 204
Carrollton, TX 75006-2962
Mailing address
1735 Keller Springs Rd
Suite 204
Carrollton, TX 75006-2962
Phone (972) 245-3455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14206 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1386653939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1735 KELLER SPRINGS RD",
"address_2": "SUITE 204",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750062962",
"telephone_number": "972-245-3455",
"fax_number": "972-242-1686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1735 KELLER SPRINGS RD",
"address_2": "SUITE 204",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750062962",
"telephone_number": "972-245-3455",
"fax_number": "972-242-1686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOBLENSVIK",
"first_name": "JON",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "14206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carrollton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.