NPIMap

Organization Active NPI

GBCC Dental PLLC

  • General Practice Dentistry
  • Glen Rose, TX
National Provider Identifier
1407397144
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
29154 Issued in TX
Legal business name
GBCC DENTAL PLLC
Practice address
1104 Bluebonnet St
Glen Rose, TX 76043
Phone
(254) 898-4646
Fax
(254) 897-7321
NPI assigned
Mar 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Authorized official

Name
Dr. Clayton K Cook, DMDNPI 1578903217
Title
Owner/Dentist
Phone
(817) 294-1090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 29154 TX Primary

Addresses

Primary practice location

1104 Bluebonnet St
Glen Rose, TX 76043

Mailing address

1104 Bluebonnet St
Glen Rose, TX 76043
Phone (254) 898-4646

Other names 1

  • Glen Rose Family Dental Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
GBCC Dental PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1104 Bluebonnet St
Glen Rose, TX 76043
Phone (254) 898-4646

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1489449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1407397144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 BLUEBONNET ST",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "76043",
            "telephone_number": "254-898-4646",
            "fax_number": "254-897-7321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 BLUEBONNET ST",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "76043",
            "telephone_number": "254-898-4646",
            "fax_number": "254-897-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GBCC DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-14",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "817-294-1090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "29154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glen Rose Family Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Glen Rose, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; 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.