NPIMap

Organization Active NPI

Bop Dental Specialists

Doing business as Brazos Kids Dental

  • Dental Clinic/Center
  • Waco, TX
National Provider Identifier
1598454191
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
BOP DENTAL SPECIALISTS
Doing business as
Brazos Kids Dental
Practice address
1605 Lake Success Dr
Waco, TX 76710-2908
Phone
(254) 224-6008
NPI assigned
May 1, 2023
Last updated
May 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Authorized official

Name
Aaron Blackwelder, DDSNPI 1629296553
Title
Manager
Phone
(254) 224-6008

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
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

1605 Lake Success Dr
Waco, TX 76710-2908

Mailing address

1121 Lake Air Dr
Waco, TX 76710-4417

Other names 1

  • Brazos Kids Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1598454191",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 LAKE SUCCESS DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102908",
            "telephone_number": "254-224-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOP DENTAL SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "BLACKWELDER",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "254-224-6008",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brazos Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 1, 2023; 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.