Prime Dental of Cedar Park PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PRIME DENTAL OF CEDAR PARK PLLC

Practice address

821 W New Hope Dr Ste 106
Cedar Park, TX 78613-2878

Phone

(512) 669-1291

NPI assigned

Oct 24, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Deepam Tiwan

Title

Manager

Phone

(512) 669-1291

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1729728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1689496358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 W NEW HOPE DR STE 106",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 W NEW HOPE DR STE 106",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132878",
            "telephone_number": "512-669-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DENTAL OF CEDAR PARK PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-24",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "TIWAN",
        "authorized_official_first_name": "DEEPAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "512-669-1291",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.