NPIMap

Organization Active NPI

Primary Dental Clinic, P.a.

  • General Practice Dentistry
  • Dallas, TX
National Provider Identifier
1669529798
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
21598 Issued in TX
Legal business name
PRIMARY DENTAL CLINIC, P.A.
Practice address
6871 Shadybrook LN
Dallas, TX 75231-6605
Phone
(469) 939-6691
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

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

Authorized official

Name
Dr. Kim Bui, DDSNPI 1134234123
Title
Secretary
Phone
(469) 939-6691

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 21598 TX Primary

Addresses

Primary practice location

6871 Shadybrook LN
Dallas, TX 75231-6605

Mailing address

1906 Village Creek Dr
Garland, TX 75040-3946
Phone (469) 939-6691

Other identifiers 3

IdentifierTypeStateIssuer
21598OtherTXSBDE TX DENTIST PROVIDER NUMBER
B21598-01OtherTXTEXAS CHIP
176322901MedicaidTX

Other names 1

  • Primary Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

6871 Shadybrook Ln
Dallas, TX 75231
Phone (469) 483-0304

Practitioners & affiliated clinicians

Practitioners 1

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": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1669529798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 VILLAGE CREEK DR",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750403946",
            "telephone_number": "469-939-6691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6871 SHADYBROOK LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752316605",
            "telephone_number": "469-939-6691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY DENTAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "BUI",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "469-939-6691",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SBDE TX DENTIST PROVIDER NUMBER",
            "identifier": "21598",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS CHIP",
            "identifier": "B21598-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176322901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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.