NPIMap

Organization Active NPI

Rodeo Laredo Dental & Orthodontics, PLLC

  • General Practice Dentistry
  • Laredo, TX
National Provider Identifier
1548611452
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RODEO LAREDO DENTAL & ORTHODONTICS, PLLC
Practice address
910 Guadalupe St Ste a
Laredo, TX 78040-5280
Phone
(817) 529-8151
NPI assigned
Jun 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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
(972) 814-2708

Specialties & licenses 1

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

Addresses

Primary practice location

910 Guadalupe St Ste a
Laredo, TX 78040-5280

Mailing address

910 Guadalupe Street, Suite a
Laredo, TX 78040-5280
Phone (817) 529-8151

Other identifiers 5

IdentifierTypeStateIssuer
182419510MedicaidTX
182419514MedicaidTX
182419515MedicaidTX
182419511MedicaidTX
182419513MedicaidTX

Other names 1

  • Rodeo Dental and Orthodontics Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1548611452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 GUADALUPE STREET, SUITE A",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780405280",
            "telephone_number": "817-529-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 GUADALUPE ST STE A",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780405280",
            "telephone_number": "817-529-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODEO LAREDO DENTAL & ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-22",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "KOUYOUMDJIAN",
        "authorized_official_first_name": "RAFFY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-814-2708",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419510",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419514",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419515",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419511",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419513",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rodeo Dental and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laredo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.