NPIMap

Organization Active NPI

TX Southern Dental PPO PC

  • Dentist
  • San Antonio, TX
National Provider Identifier
1497525950
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TX SOUTHERN DENTAL PPO PC
Practice address
1402 SW Military Dr
San Antonio, TX 78221-1556
Phone
(210) 923-8066
NPI assigned
Jan 5, 2024
Organization subpart
Yes
Parent organization
TX SOUTHERN DENTAL PPO PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Christine Nelson
Title
VP, Revenue Cycle
Phone
(469) 450-6482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1402 SW Military Dr
San Antonio, TX 78221-1556

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Other names 1

  • Sunrise Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
TX Southern Dental PPO PC40 organizations share this tax ID, including this one
Part of
TX Southern Dental PPO PC

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1497525950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 GRANITE PKWY STE 780",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 SW MILITARY DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782211556",
            "telephone_number": "210-923-8066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TX SOUTHERN DENTAL PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TX SOUTHERN DENTAL PPO PC",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "VP, REVENUE CYCLE",
        "authorized_official_telephone_number": "469-450-6482"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.

Verify at the official NPI Registry.