Custom Dental of the Colony, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CUSTOM DENTAL OF THE COLONY, PLLC

Practice address

4695 N Colony Blvd Ste 104
The Colony, TX 75056-3330

Phone

(972) 625-0213

NPI assigned

Jan 9, 2022

Organization subpart

No

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

Authorized official

Name

Rene Rodgers

Title

Coo

Phone

(405) 227-6100

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jo Ann Thiel, D.D.S., P.A

  • General Practice Dentistry
  • The Colony, TX
  • NPI 1194833574
  NPD (past)

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

{
    "created_epoch": "1641686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641686400000",
    "number": "1568123719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4695 N COLONY BLVD STE 104",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750563330",
            "telephone_number": "972-625-0213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4695 N COLONY BLVD STE 104",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750563330",
            "telephone_number": "972-625-0213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM DENTAL OF THE COLONY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-09",
        "last_updated": "2022-01-09",
        "certification_date": "2022-01-09",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "405-227-6100"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in The Colony, TX
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.