Dental Provider Resources 3

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTAL PROVIDER RESOURCES 3

Practice address

458 Mid Cities Blvd
Hurst, TX 76054

Phone

(817) 571-2100

NPI assigned

Jun 20, 2012

Organization subpart

No

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

Authorized official

Name

Jared Bruggeman, DDS

Title

Owner/Doctor

Phone

(817) 328-6150

Specialties & licenses 1

Addresses

Other names 1

• Radiant Smiles Mid Cities Doing business as

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1649533191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 TEXAN TRAIL STE 229",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "76051",
            "telephone_number": "817-328-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 MID CITIES BLVD",
            "city": "HURST",
            "state": "TX",
            "postal_code": "76054",
            "telephone_number": "817-571-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROVIDER RESOURCES 3",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "BRUGGEMAN",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "817-328-6150",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Smiles Mid Cities",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Jason Delgado, D.D.S., M.S.
• Zaira Delgado, SLP-A
• Delivering Blessings, LLC
• Yanci Deng, PHARM D
• Tiffany Michelle Denny, PT
• Bhawna Deo
• Shruti Desai, PA-C
• Rabiha Kiran Ali Dewany, MS, OTR/L
• DFW Counseling and Psychological Services, Inc
• DFW Endodontic Associates, P.a.

• General Practice Dentistry in Hurst, TX
• Providers in Hurst, 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 Jun 20, 2012; 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.