Pediatric Dentristry of Mansfield,PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTRISTRY OF MANSFIELD,PLLC

Practice address

1830 E Broad St
Ste104
Mansfield, TX 76063-9162

Phone

(817) 473-7171

Fax

(817) 473-2594

NPI assigned

Nov 23, 2011

Organization subpart

No

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

Authorized official

Name

Deborah C. Sullivan, DDS, MS PC

Title

Owner

Phone

(817) 473-7171

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Corey Menou, DDS

  • Pediatric Dentistry
  • Mansfield, TX
  • NPI 1679014567
  NPD (past)
• Daniel E Wright, D.D.S.

  • Pediatric Dentistry
  • Mansfield, TX
  • NPI 1396901922
  NPD (past)

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1508133224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 E BROAD ST STE 104",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760639161",
            "telephone_number": "817-473-7171",
            "fax_number": "817-473-2594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 E BROAD ST",
            "address_2": "STE104",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760639162",
            "telephone_number": "817-473-7171",
            "fax_number": "817-473-2594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTRISTRY OF MANSFIELD,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-23",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-473-7171",
        "authorized_official_credential": "DDS, MS PC"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peak Physical Therapy, LLC
• Jessica Pearce, DO
• Jenny Pearson
• Katherine Pederson, D.O.
• Pediatric Counseling of Mansfield, PLLC
• Pediatric Therapy Together LLC
• Pegasus Caregivers Inc
• Genesis Pereyra
• Carlos S Perez Gonzalez, DPT
• Elias Perez

• Pediatric Dentistry in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.