NPIMap

Organization Active NPI

Waco Kids Dental PC

  • Pediatric Dentistry
  • Waco, TX
National Provider Identifier
1598041659
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
22764 Issued in TX
Legal business name
WACO KIDS DENTAL PC
Practice address
1121 Lake Air Dr
Waco, TX 76710-4417
Phone
(254) 772-8330
NPI assigned
Nov 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Authorized official

Name
Aaron Blackwelder, DDSNPI 1629296553
Title
President
Phone
(254) 772-8330

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 22764 TX Primary

Addresses

Primary practice location

1121 Lake Air Dr
Waco, TX 76710-4417

Mailing address

1121 Lake Air Dr
Waco, TX 76710-4417
Phone (254) 772-8330

National Provider Directory

National Provider Directory

Locations

1121 Lake Air Dr
Waco, TX 76710
Phone (254) 772-8330

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1598041659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 LAKE AIR DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104417",
            "telephone_number": "254-772-8330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 LAKE AIR DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104417",
            "telephone_number": "254-772-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACO KIDS DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-02",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "BLACKWELDER",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "254-772-8330",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "22764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; 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.