NPIMap

Organization Active NPI

Texas Dental Orthodontics Practice, PLLC

  • General Practice Dentistry
  • Boerne, TX
National Provider Identifier
1396478277
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TEXAS DENTAL ORTHODONTICS PRACTICE, PLLC
Practice address
804 N Main St
Boerne, TX 78006-1626
Phone
(830) 249-8407
NPI assigned
Jul 7, 2022
Organization subpart
Yes
Parent organization
TEXAS DENTAL ORTHODONTICS PRACTICE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

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

Authorized official

Name
Gregory Kostelac
Title
Data Analyst
Phone
(719) 372-5605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

804 N Main St
Boerne, TX 78006-1626

Mailing address

6110 Barnes Rd
Colorado Springs, CO 80922-2600

Other names 1

  • San Antonio Orthodontic Group Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Texas Dental Orthodontics Practice PLLC6 organizations share this tax ID, including this one
Part of
Texas Dental Orthodontics Practice PLLC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657152000000",
    "number": "1396478277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6110 BARNES RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809222600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 N MAIN ST",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780061626",
            "telephone_number": "830-249-8407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS DENTAL ORTHODONTICS PRACTICE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEXAS DENTAL ORTHODONTICS PRACTICE, PLLC",
        "enumeration_date": "2022-07-07",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A",
        "authorized_official_last_name": "KOSTELAC",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "DATA ANALYST",
        "authorized_official_telephone_number": "719-372-5605"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Antonio Orthodontic Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boerne, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.