Magnolia Park Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

23238 Issued in TX

Legal business name

MAGNOLIA PARK DENTAL, PLLC

Doing business as

Magnolia Park Dental

Practice address

651 N Denton Tap Rd
Suite 170
Coppell, TX 75019-2007

Phone

(972) 899-4900

Fax

(972) 899-4928

NPI assigned

Apr 13, 2012

Organization subpart

No

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

Authorized official

Name

Brady Jonathan Camp, DDS

Title

Owner

Phone

(972) 899-4900

Specialties & licenses 1

Addresses

Other names 1

• Magnolia Park Dental Doing business as

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1689931735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 N DENTON TAP RD",
            "address_2": "SUITE 170",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750192007",
            "telephone_number": "972-899-4900",
            "fax_number": "972-899-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 N DENTON TAP RD",
            "address_2": "SUITE 170",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750192007",
            "telephone_number": "972-899-4900",
            "fax_number": "972-899-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PARK DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-13",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "CAMP",
        "authorized_official_first_name": "BRADY",
        "authorized_official_middle_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-899-4900",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "23238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Coppell, TX
• Providers in Coppell, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.