Individual provider Active NPI

Dheepa Jagadeesan, D.D.S

  • Dentist
  • Dallas, TX
National Provider Identifier
1669660536
Registry record updated Feb 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
56141 Issued in CA
Practice address
3010 LBJ Fwy
Suite 200
Dallas, TX 75234-7770
Phone
(424) 247-8708
NPI assigned
Oct 4, 2007
Last updated
Feb 1, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 56141 CA Primary

Addresses

Primary practice location

3010 LBJ Fwy
Suite 200
Dallas, TX 75234-7770

Mailing address

7936 N Macarthur Blvd
Apt 1129
Irving, TX 75063-3742
Phone (424) 247-8708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150611000288 TX Order and Referring Only - DentistPractitioner - Dentist 3375864770

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296518400000",
    "number": "1669660536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7936 N MACARTHUR BLVD",
            "address_2": "APT 1129",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750633742",
            "telephone_number": "424-247-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 LBJ FWY",
            "address_2": "SUITE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752347770",
            "telephone_number": "424-247-8708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGADEESAN",
        "first_name": "DHEEPA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2011-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.