Active NPI
Jennifer Tracy Phu, DDS
- Dentist
- Dallas, TX
National Provider Identifier
1407136195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 26548
- Practice address
- 10830 N. Central Expressway, Suite 495
Mobile Dental Care
Dallas, TX 75231 - Phone
- (214) 750-6860
- NPI assigned
- Aug 25, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 26548 | TX | Primary |
Addresses
Primary practice location
10830 N. Central Expressway, Suite 495
Mobile Dental Care
Dallas, TX 75231
Mailing address
828 Snapdragon LN
Plano, TX 75075-2365
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 |
|---|---|---|---|
| 26548 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John D. Wallace, DDS, MD, PA | Past | Accepting new patients | |
| Mobile Dental Care Pma, LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Oral and Maxillofacial Surgery (Dentist)
- Dallas, TX
- NPI 1356535314
-
- Dentist
- Dallas, TX
- NPI 1154715753
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388707200000",
"number": "1407136195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "828 SNAPDRAGON LN",
"city": "PLANO",
"state": "TX",
"postal_code": "750752365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10830 N. CENTRAL EXPRESSWAY, SUITE 495",
"address_2": "MOBILE DENTAL CARE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75231",
"telephone_number": "214-750-6860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHU",
"first_name": "JENNIFER",
"middle_name": "TRACY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-25",
"last_updated": "2014-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "26548",
"primary": true
}
],
"identifiers": [],
"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 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.