Active NPI
Ryan Greg Anderson, DMD
- Dentist
- Mansfield, TX
National Provider Identifier
1679829923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 28081
- Practice address
- 2771 E Broad St Ste 221
Mansfield, TX 76063-9157 - Phone
- (435) 531-6385
- Fax
- (817) 473-2251
- NPI assigned
- Jul 24, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 28081 | TX | Primary |
Addresses
Primary practice location
2771 E Broad St Ste 221
Mansfield, TX 76063-9157
Mailing address
520 E Vine St Unit 484
Keller, TX 76248-2300
Phone (817) 318-6329
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 |
|---|---|---|---|
| 28081 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670371200000",
"number": "1679829923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 E VINE ST UNIT 484",
"city": "KELLER",
"state": "TX",
"postal_code": "762482300",
"telephone_number": "817-318-6329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2771 E BROAD ST STE 221",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760639157",
"telephone_number": "435-531-6385",
"fax_number": "817-473-2251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "RYAN",
"middle_name": "GREG",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-24",
"last_updated": "2022-12-07",
"certification_date": "2022-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "28081",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.