NPIMap

Organization Active NPI

Killeen Family Dentistry

  • General Practice Dentistry
  • Killeen, TX
National Provider Identifier
1508958117
Registry record updated May 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KILLEEN FAMILY DENTISTRY
Practice address
3300 E Central Texas Expy
Suite #302
Killeen, TX 76543-5306
Phone
(254) 699-6799
Fax
(254) 699-3465
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2014

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

Authorized official

Name
Mr. Andre Yassa, DDSNPI 1518140276
Title
Direct Owner
Phone
(254) 699-6799

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3300 E Central Texas Expy
Suite #302
Killeen, TX 76543-5306

Mailing address

3300 E Central Texas Expy
Suite #302
Killeen, TX 76543-5306
Phone (254) 699-6799

Other identifiers 2

IdentifierTypeStateIssuer
G60488-1OtherTXTEXAS CHIP
172223301MedicaidTX

National Provider Directory

National Provider Directory

Locations

3300 E Central Texas Expy
Ste 302
Killeen, TX 76543
Phone (254) 699-6799

Practitioners & affiliated clinicians

Practitioners 6

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": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1508958117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E CENTRAL TEXAS EXPY",
            "address_2": "SUITE #302",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765435306",
            "telephone_number": "254-699-6799",
            "fax_number": "254-699-3465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 E CENTRAL TEXAS EXPY",
            "address_2": "SUITE #302",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765435306",
            "telephone_number": "254-699-6799",
            "fax_number": "254-699-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILLEEN FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2014-05-14",
        "status": "A",
        "authorized_official_last_name": "YASSA",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "254-699-6799",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS CHIP",
            "identifier": "G60488-1",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172223301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.