NPIMap

Organization Active NPI

Mimi Family Dental

  • Dentist
  • Fort Worth, TX
National Provider Identifier
1396988150
Registry record updated Apr 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MIMI FAMILY DENTAL
Practice address
1200 Overlook Ter
Suite C
Fort Worth, TX 76112-2382
Phone
(817) 451-8855
Fax
(817) 457-8860
NPI assigned
Apr 9, 2009
Last updated
Apr 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2009

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

Authorized official

Name
Mrs. Lee Lang
Title
Office Manager
Phone
(817) 451-8855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1200 Overlook Ter
Suite C
Fort Worth, TX 76112-2382

Mailing address

1200 Overlook Ter
Suite C
Fort Worth, TX 76112-2382
Phone (817) 451-8855

National Provider Directory

National Provider Directory

Locations

1200 Overlook Ter
Ste C
Fort Worth, TX 76112
Phone (817) 451-8855

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": "1239235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239235200000",
    "number": "1396988150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 OVERLOOK TER",
            "address_2": "SUITE C",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761122382",
            "telephone_number": "817-451-8855",
            "fax_number": "817-457-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 OVERLOOK TER",
            "address_2": "SUITE C",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761122382",
            "telephone_number": "817-451-8855",
            "fax_number": "817-457-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMI FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-09",
        "last_updated": "2009-04-09",
        "status": "A",
        "authorized_official_last_name": "LANG",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "817-451-8855",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; 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.