Active NPI
Dentrust Dental Texas, P.C.
- General Practice Dentistry
- Ft. Hood, TX
National Provider Identifier
1407521180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- DENTRUST DENTAL TEXAS, P.C.
- Practice address
- 4250 Clear Creek Rd
#213
Ft. Hood, TX 76544 - Phone
- (254) 423-9234
- Fax
- (254) 312-7441
- NPI assigned
- Aug 13, 2021
- Organization subpart
- Yes
- Parent organization
- DENTRUST DENTAL TEXAS, PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amanda Anne Clark
- Title
- Director of Credentialing
- Phone
- (267) 927-5000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | Primary |
Addresses
Primary practice location
4250 Clear Creek Rd
#213
Ft. Hood, TX 76544
Mailing address
1221 Vinewood Dr
Seffner, FL 33584-4829
Phone (813) 451-4503
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18598 | Other | TX | LC LICENSE |
Other names 1
- DOCS Ft. Hood
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | fthoodinfo@docs.health |
National Provider Directory
National Provider Directory- Part of
- Dentrust Dental Texas PC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628812800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1628812800000",
"number": "1407521180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 VINEWOOD DR",
"city": "SEFFNER",
"state": "FL",
"postal_code": "335844829",
"telephone_number": "813-451-4503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4250 CLEAR CREEK RD",
"address_2": "#213",
"city": "FT. HOOD",
"state": "TX",
"postal_code": "76544",
"telephone_number": "254-423-9234",
"fax_number": "254-312-7441"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DENTRUST DENTAL TEXAS, P.C.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DENTRUST DENTAL TEXAS, PC",
"enumeration_date": "2021-08-13",
"last_updated": "2021-08-13",
"certification_date": "2021-07-20",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "AMANDA",
"authorized_official_middle_name": "ANNE",
"authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
"authorized_official_telephone_number": "267-927-5000"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LC LICENSE",
"identifier": "18598",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "fthoodinfo@docs.health",
"affiliation": "N",
"address_1": "4250 Clear Creek Rd",
"address_2": "#213",
"city": "Ft. Hood",
"state": "TX",
"country_code": "US",
"postal_code": "76544",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "DOCS Ft. Hood",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ft. Hood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.