Blossom Orthodontics and Pediatric Dentistry PA

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

BLOSSOM ORTHODONTICS AND PEDIATRIC DENTISTRY PA

Practice address

13119 Louetta Rd
Cypress, TX 77429-5155

Phone

(281) 359-5551

NPI assigned

Feb 16, 2016

Last updated

Feb 16, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shunda Thompson, DDS

Title

Owner

Phone

(281) 359-5551

Specialties & licenses 5

Addresses

Locations

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

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1518326750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 VINTAGE PARK BLVD",
            "address_2": "SUITE A 109",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770703998",
            "telephone_number": "281-359-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13119 LOUETTA RD",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774295155",
            "telephone_number": "281-359-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM ORTHODONTICS AND PEDIATRIC DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-16",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "SHUNDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-359-5551",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.