Southern Dental at Baybrook PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30690 Issued in TX

Legal business name

SOUTHERN DENTAL AT BAYBROOK PLLC

Practice address

1235 W Bay Area Blvd
Webster, TX 77598-3832

Phone

(281) 332-6780

NPI assigned

Jul 17, 2015

Last updated

Jul 17, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Steven Wingfield

Title

Sole MBR

Phone

(678) 906-1769

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437091200000",
    "number": "1639553746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 W BAY AREA BLVD",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775983832",
            "telephone_number": "281-332-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 W BAY AREA BLVD",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775983832",
            "telephone_number": "281-332-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DENTAL AT BAYBROOK PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A",
        "authorized_official_last_name": "WINGFIELD",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "678-906-1769"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Webster, TX
• Providers in Webster, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.

Verify at the official NPI Registry.