1488 Dental Clinics Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

25198 Issued in TX

Legal business name

1488 DENTAL CLINICS INC

Practice address

469 FM 1488 Rd
Ste 103
Conroe, TX 77384-4188

Phone

(936) 242-1490

Fax

(936) 242-1388

NPI assigned

Dec 8, 2015

Last updated

Dec 8, 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

Dr. Mbachan Okwen, DDS MBA

Title

Owner

Phone

(936) 242-1490

Specialties & licenses 1

Addresses

Other names 1

• 1488 Dental Other name

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

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1649645268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "469 FM 1488 RD",
            "address_2": "STE 103",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773844188",
            "telephone_number": "936-242-1490",
            "fax_number": "936-242-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 FM 1488 RD",
            "address_2": "STE 103",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773844188",
            "telephone_number": "936-242-1490",
            "fax_number": "936-242-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1488 DENTAL CLINICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-08",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "OKWEN",
        "authorized_official_first_name": "MBACHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-242-1490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MBA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1488 Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• General Practice Dentistry in Conroe, TX
• Providers in Conroe, 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 Dec 8, 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.