NPIMap

Organization Active NPI

East Texas Children's Dentistry, P.a.

  • Pediatric Dentistry
  • Mount Pleasant, TX
National Provider Identifier
1528232006
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
TX 20214 Issued in TX
Legal business name
EAST TEXAS CHILDREN'S DENTISTRY, P.A.
Practice address
203 W 20TH St
Suite B
Mt Pleasant, TX 75455-1101
Phone
(903) 577-9900
Fax
(903) 577-9901
NPI assigned
Apr 16, 2008
Last updated
Apr 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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

Authorized official

Name
Dr. Kenneth C. Thompson, D.D.S.NPI 1689697237
Title
Dentist
Phone
(903) 577-9900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X TX10422 TX
Pediatric Dentistry 1223P0221X TX 20214 TX Primary

Addresses

Primary practice location

203 W 20TH St
Suite B
Mt Pleasant, TX 75455-1101

Mailing address

203 W 20TH St
Suite B
Mt Pleasant, TX 75455-1101
Phone (903) 577-9900

Other identifiers 2

IdentifierTypeStateIssuer
87D558OtherTXBCBS OF TEXAS
1387039OtherTXUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

203 W 20th St
Ste B
Mt Pleasant, TX 75455
Phone (903) 577-8878

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1528232006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 W 20TH ST",
            "address_2": "SUITE B",
            "city": "MT PLEASANT",
            "state": "TX",
            "postal_code": "754551101",
            "telephone_number": "903-577-9900",
            "fax_number": "903-577-9901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 W 20TH ST",
            "address_2": "SUITE B",
            "city": "MT PLEASANT",
            "state": "TX",
            "postal_code": "754551101",
            "telephone_number": "903-577-9900",
            "fax_number": "903-577-9901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS CHILDREN'S DENTISTRY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "903-577-9900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "TX10422",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "TX 20214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "87D558",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1387039",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; 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.