NPIMap

Organization Active NPI

Saint Apollonia Medicaid Dental Clinic of Texas, PA

  • General Practice Dentistry
  • El Campo, TX
National Provider Identifier
1447427422
Registry record updated May 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20250 Issued in TX
Legal business name
SAINT APOLLONIA MEDICAID DENTAL CLINIC OF TEXAS, PA
Practice address
1108 N Mechanic St
El Campo, TX 77437-3030
Phone
(979) 541-5400
Fax
(979) 541-5462
NPI assigned
May 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2008

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

Authorized official

Name
Dr. Ross Wyatt Anderson, DDS
Title
President
Phone
(979) 541-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 20250 TX Primary

Addresses

Primary practice location

1108 N Mechanic St
El Campo, TX 77437-3030

Mailing address

1108 N Mechanic St
El Campo, TX 77437-3030
Phone (979) 541-5400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1447427422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 N MECHANIC ST",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774373030",
            "telephone_number": "979-541-5400",
            "fax_number": "979-541-5462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 N MECHANIC ST",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774373030",
            "telephone_number": "979-541-5400",
            "fax_number": "979-541-5462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT APOLLONIA MEDICAID DENTAL CLINIC OF TEXAS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "WYATT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-541-5400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "20250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Campo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.