NPIMap

Organization Active NPI

Longevity Dental

  • Dental Clinic/Center
  • Rockwall, TX
National Provider Identifier
1669989240
Registry record updated Jan 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
17186 Issued in TX
Legal business name
LONGEVITY DENTAL
Practice address
510 Turtle Cove Blvd Ste 107
Rockwall, TX 75087-5374
Phone
(972) 771-0977
NPI assigned
Jan 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2018

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

Authorized official

Name
Ronald G EvansNPI 1144379306
Title
Sole MBR
Phone
(972) 771-0977

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
Dental Clinic/Center 261QD0000X 17186 TX Primary

Addresses

Primary practice location

510 Turtle Cove Blvd Ste 107
Rockwall, TX 75087-5374

Mailing address

510 Turtle Cove Blvd Ste 107
Rockwall, TX 75087-5374

National Provider Directory

National Provider Directory

Locations

510 Turtle Cove Blvd
Ste 107
Rockwall, TX 75087
Phone (972) 771-0977

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": "1515110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515110400000",
    "number": "1669989240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 TURTLE COVE BLVD STE 107",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750875374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 TURTLE COVE BLVD STE 107",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750875374",
            "telephone_number": "972-771-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-05",
        "last_updated": "2018-01-05",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "972-771-0977"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "17186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2018; 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.