Active NPI
C. N. Deepak, MDS
- Periodontics
- Arlington, TX
National Provider Identifier
1417014812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 21191
- Practice address
- 5760 W Pleasant Ridge Rd Ste 110
Arlington, TX 76016-4482 - Phone
- (817) 561-9199
- NPI assigned
- Jan 3, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 21191 | TX | Primary |
Addresses
Primary practice location
5760 W Pleasant Ridge Rd Ste 110
Arlington, TX 76016-4482
Mailing address
650 International Pkwy
Suite 100
Richardson, TX 75081-6612
Phone (817) 540-2552
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 |
|---|---|---|---|
| 21191 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1417014812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 INTERNATIONAL PKWY",
"address_2": "SUITE 100",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750816612",
"telephone_number": "817-540-2552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5760 W PLEASANT RIDGE RD STE 110",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760164482",
"telephone_number": "817-561-9199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEEPAK",
"first_name": "C. N.",
"credential": "MDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "21191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.