NPIMap

Organization Active NPI

Dental Delite PG PA

  • Dentist
  • Dallas, TX
National Provider Identifier
1528235769
Registry record updated Mar 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13654 Issued in TX
Legal business name
DENTAL DELITE PG PA
Practice address
8228 Bruton Rd
Dallas, TX 75217-1902
Phone
(214) 398-1234
NPI assigned
May 15, 2008
Last updated
Mar 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2013

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

Authorized official

Name
Valarie Bohannon
Title
Office Manager
Phone
(214) 398-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 13654 TX Primary

Addresses

Primary practice location

8228 Bruton Rd
Dallas, TX 75217-1902

Mailing address

8228 Bruton Rd
Dallas, TX 75217-1902

Other identifiers 1

IdentifierTypeStateIssuer
090281902MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Dental Delite PG PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362960000000",
    "number": "1528235769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8228 BRUTON RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752171902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8228 BRUTON RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752171902",
            "telephone_number": "214-398-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DELITE PG PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2013-03-11",
        "status": "A",
        "authorized_official_last_name": "BOHANNON",
        "authorized_official_first_name": "VALARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "214-398-1234"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "13654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090281902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; 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.