Trinity Magnolia Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21047 Issued in TX

Legal business name

TRINITY MAGNOLIA DENTAL PLLC

Practice address

18640 FM 1488 Rd Ste I
Magnolia, TX 77354-8517

Phone

(832) 648-7632

Fax

(832) 532-1904

NPI assigned

Jun 27, 2018

Organization subpart

No

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

Authorized official

Name

Ruben Lopez

Title

Director of Operations

Phone

(832) 648-7632

Specialties & licenses 2

Addresses

Other names 1

• Trinity Dental Doing business as

Locations

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1508351016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 N SAM HOUSTON PKWY E STE 565",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770604021",
            "telephone_number": "832-648-7632",
            "fax_number": "832-532-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18640 FM 1488 RD STE I",
            "city": "MAGNOLIA",
            "state": "TX",
            "postal_code": "773548517",
            "telephone_number": "832-648-7632",
            "fax_number": "832-532-1904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY MAGNOLIA DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-27",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "832-648-7632"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "21047",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trinity Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; 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.