NPIMap

Organization Active NPI

Tesla Dental Implant LLC

  • Orofacial Pain Dentistry
  • Keller, TX
National Provider Identifier
1487398285
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orofacial Pain DentistryTaxonomy code 1223X2210X
Legal business name
TESLA DENTAL IMPLANT LLC
Practice address
151 Ridge Point Pkwy Ste 400
Keller, TX 76248-8801
Phone
(817) 835-6955
NPI assigned
Apr 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Authorized official

Name
Prof. Sam Wise, DDS, MOM, MSC, MDSNPI 1417416728
Title
Owner
Phone
(973) 747-6425

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Orofacial Pain DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X2210X Primary
Dental Clinic/Center 261QD0000X
Radiology Clinic/Center 261QR0200X
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X
Sleep Disorder Diagnostic Clinic/Center 261QS1200X
Dental Laboratory 292200000X

Addresses

Primary practice location

151 Ridge Point Pkwy Ste 400
Keller, TX 76248-8801

Mailing address

5605 FM 423
Suit 500 #410
Frisco, TX 75036
Phone (973) 747-6425

National Provider Directory

National Provider Directory

Locations

151 Ridge Point Pkwy
Ste 400
Keller, TX 76248
Phone (817) 835-6955

Practitioners & affiliated clinicians

Practitioners 1

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": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1487398285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5605 FM 423",
            "address_2": "SUIT 500 #410",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "75036",
            "telephone_number": "973-747-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 RIDGE POINT PKWY STE 400",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762488801",
            "telephone_number": "817-835-6955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TESLA DENTAL IMPLANT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-747-6425",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "DDS, MOM, MSC, MDS"
    },
    "taxonomies": [
        {
            "code": "1223X2210X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orofacial Pain",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keller, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.