Active NPI
Benjamin Ty PO Jr., D.D.S.
- Pediatric Dentistry
- Katy, TX
National Provider Identifier
1679585756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 14885
- Practice address
- 2840 Commercial Center Blvd
Suite 101
Katy, TX 77494-6411 - Phone
- (281) 693-9100
- Fax
- (281) 693-9101
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 14885 | TX | Primary |
Addresses
Primary practice location
2840 Commercial Center Blvd
Suite 101
Katy, TX 77494-6411
Mailing address
32003 Wendt Park Trce
Fulshear, TX 77441-4187
Phone (281) 346-0640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14885 | TX | MD | Chiropractor |
| 1030 | AK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679585756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32003 WENDT PARK TRCE",
"city": "FULSHEAR",
"state": "TX",
"postal_code": "774414187",
"telephone_number": "281-346-0640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2840 COMMERCIAL CENTER BLVD",
"address_2": "SUITE 101",
"city": "KATY",
"state": "TX",
"postal_code": "774946411",
"telephone_number": "281-693-9100",
"fax_number": "281-693-9101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PO",
"first_name": "BENJAMIN",
"middle_name": "TY",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "14885",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Katy, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.