Active NPI
Tatyana Haddock, D.D.S.
- General Practice Dentistry
- Round Rock, TX
National Provider Identifier
1568557247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 19798
- Practice address
- 836 Red Bud LN
Round Rock, TX 78664-9780 - Phone
- (512) 419-8208
- NPI assigned
- Oct 4, 2006
- Last updated
- Jun 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 19798 | TX | Primary |
Addresses
Primary practice location
836 Red Bud LN
Round Rock, TX 78664-9780
Mailing address
836 Red Bud LN
Round Rock, TX 78664-9780
Phone (512) 419-8208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19798 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433289600000",
"number": "1568557247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "836 RED BUD LN",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786649780",
"telephone_number": "512-419-8208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "836 RED BUD LN",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786649780",
"telephone_number": "512-419-8208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADDOCK",
"first_name": "TATYANA",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2015-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "19798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Rock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.