Elite Dental Associates - Firewheel, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18994 Issued in TX

Legal business name

ELITE DENTAL ASSOCIATES - FIREWHEEL, PC

Doing business as

Watermark Dental

Practice address

5435 N Garland Ave Ste 125
Garland, TX 75040-2723

Phone

(972) 530-7374

Fax

(214) 452-8203

NPI assigned

Jul 23, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Andy C Chang, DDS MS

Title

Owner / Operator

Phone

(214) 220-2424

Specialties & licenses 1

Addresses

Other names 1

• Watermark Dental Doing business as

Locations

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

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279843200000",
    "number": "1417260001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5435 N GARLAND AVE STE 125",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750402723",
            "telephone_number": "972-530-7374",
            "fax_number": "214-452-8203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5435 N GARLAND AVE STE 125",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750402723",
            "telephone_number": "972-530-7374",
            "fax_number": "214-452-8203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL ASSOCIATES - FIREWHEEL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-23",
        "last_updated": "2010-07-23",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "ANDY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER / OPERATOR",
        "authorized_official_telephone_number": "214-220-2424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "18994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Watermark Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Garland, TX
• Providers in Garland, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; 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.