NPIMap

Organization Active NPI

Rodeo Dental San Benito, PLLC

  • General Practice Dentistry
  • San Benito, TX
National Provider Identifier
1528350782
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RODEO DENTAL SAN BENITO, PLLC
Practice address
1141 US Business 77
Suite G
San Benito, TX 78586-4376
Phone
(956) 361-3377
Fax
(817) 928-1681
NPI assigned
May 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

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

Authorized official

Name
Dr. Raffy Kouyoumdjian, DMD
Title
Owner
Phone
(817) 529-8151

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1141 US Business 77
Suite G
San Benito, TX 78586-4376

Mailing address

100 E. 15TH St.
Suite 520
Fort Worth, TX 76102-6566
Phone (817) 529-8151

Other names 1

  • Rodeo Dental and Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Rodeo Dental and Orthodontics2 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": "1304640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666742400000",
    "number": "1528350782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E. 15TH ST.",
            "address_2": "SUITE 520",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761026566",
            "telephone_number": "817-529-8151",
            "fax_number": "817-928-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 US BUSINESS 77",
            "address_2": "SUITE G",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785864376",
            "telephone_number": "956-361-3377",
            "fax_number": "817-928-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODEO DENTAL SAN BENITO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-06",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "KOUYOUMDJIAN",
        "authorized_official_first_name": "RAFFY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-529-8151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rodeo Dental and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Benito, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; 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.