Active NPI
Jack B Siegrist Jr., D.D.S.
- General Practice Dentistry
- Irving, TX
National Provider Identifier
1457484461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9950
- Practice address
- 5205 N O Connor Blvd
#150
Irving, TX 75039-3707 - Phone
- (972) 556-2122
- Fax
- (972) 556-2331
- NPI assigned
- Mar 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9950 | TX | Primary |
Addresses
Primary practice location
5205 N O Connor Blvd
#150
Irving, TX 75039-3707
Mailing address
2100 Tree Top CT
Granbury, TX 76049-8067
Phone (972) 556-2122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150522000163 | TX | Order and Referring Only - Dentist | 8325368947 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9950 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457484461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 TREE TOP CT",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760498067",
"telephone_number": "972-556-2122",
"fax_number": "972-556-2331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5205 N O CONNOR BLVD",
"address_2": "#150",
"city": "IRVING",
"state": "TX",
"postal_code": "750393707",
"telephone_number": "972-556-2122",
"fax_number": "972-556-2331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEGRIST",
"first_name": "JACK",
"middle_name": "B",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "9950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.