Flint Dental Group

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

FLINT DENTAL GROUP

Doing business as

Creekside Dental

Practice address

17159 FM 2493
Flint, TX 75762-8331

Phone

(064) 903-8946

NPI assigned

Sep 2, 2020

Last updated

Sep 2, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. William Robert Jennings DDS, DDS

Title

Owner/Sole Member

Phone

(940) 206-8956

Specialties & licenses 1

Addresses

Other names 1

• Creekside Dental Doing business as

Electronic endpoints 1

Locations

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.

• William Robert Jennings, DDS

  • General Practice Dentistry
  • Tyler, TX
  • NPI 1902829070
  NPD (past)

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1407460975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4324 LAZY CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757071554",
            "telephone_number": "903-330-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17159 FM 2493",
            "city": "FLINT",
            "state": "TX",
            "postal_code": "757628331",
            "telephone_number": "064-903-8946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLINT DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "JENNINGS DDS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/SOLE MEMBER",
        "authorized_official_telephone_number": "940-206-8956",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "drjennings@pearlstreetdentalpartners.com",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "17159 Fm 2493",
            "city": "Flint",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757628331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Creekside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly Nicole Ellis, RN
• Etmc Physician Group Inc.
• Excel Home Medical
• Connie Sue Fiser, APRN, A-GNP, BC
• Flawless Medical Aesthetics PLLC
• Tierny Foard, LMFT-A
• Yatasca Fountain-London, COTA
• Kimberly Christine Fowler, LPC
• Ronald Gilbert, NP-C
• Brandon Michael Gill, RN

• Dental Clinic/Center in Flint, TX
• Providers in Flint, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; 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.