NPIMap

Organization Active NPI

Village DDS PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Dallas, TX
National Provider Identifier
1396101010
Registry record updated Jan 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
24314 Issued in TX
Legal business name
VILLAGE DDS PLLC
Practice address
4041 W Wheatland Rd
Suite 202
Dallas, TX 75237-4063
Phone
(817) 306-1738
Fax
(817) 306-7366
NPI assigned
Jan 11, 2016
Last updated
Jan 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2016

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

Authorized official

Name
Omar FetouhNPI 1992950042
Title
Owner
Phone
(716) 348-9855

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 30316 TX
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 24314 TX Primary

Addresses

Primary practice location

4041 W Wheatland Rd
Suite 202
Dallas, TX 75237-4063

Mailing address

4041 W Wheatland Rd
Suite 202
Dallas, TX 75237-4063
Phone (817) 306-1738

Other identifiers 2

IdentifierTypeStateIssuer
1568871523MedicaidTX
1992950042MedicaidTX

National Provider Directory

National Provider Directory

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": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452470400000",
    "number": "1396101010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 W WHEATLAND RD",
            "address_2": "SUITE 202",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752374063",
            "telephone_number": "817-306-1738",
            "fax_number": "817-306-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 W WHEATLAND RD",
            "address_2": "SUITE 202",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752374063",
            "telephone_number": "817-306-1738",
            "fax_number": "817-306-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2016-01-11",
        "status": "A",
        "authorized_official_last_name": "FETOUH",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-348-9855"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30316",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "24314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568871523",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992950042",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.