The Dentist Off Main, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19398 Issued in TX

Legal business name

THE DENTIST OFF MAIN, PLLC

Practice address

1245 S. Main St.
Suite 100
Grapevine, TX 76051

Phone

(817) 527-1590

Fax

(940) 497-3010

NPI assigned

Jun 19, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Richard Bernard Luczak, DDS, MPHNPI 1528208568

Title

Ceo

Phone

(817) 527-1590

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Bernard Luczak, DDS, MPH

  • General Practice Dentistry
  • Grapevine, TX
  • NPI 1528208568
  NPD (past) Authorized official

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371600000000",
    "number": "1396184693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 S. MAIN ST.",
            "address_2": "SUITE 100",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "76051",
            "telephone_number": "817-527-1590",
            "fax_number": "940-497-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 S. MAIN ST.",
            "address_2": "SUITE 100",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "76051",
            "telephone_number": "817-527-1590",
            "fax_number": "940-497-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTIST OFF MAIN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2013-06-19",
        "status": "A",
        "authorized_official_last_name": "LUCZAK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-527-1590",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS, MPH"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "19398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "870515",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Grapevine, TX
• Providers in Grapevine, 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 Jun 19, 2013; 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.