NPIMap

Organization Active NPI

Modern Dental Professionals San Antonio PC

Doing business as Castle Dental

  • Dentist
  • San Antonio, TX
National Provider Identifier
1720158496
Registry record updated Dec 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20569 Issued in TX
Legal business name
MODERN DENTAL PROFESSIONALS SAN ANTONIO PC
Doing business as
Castle Dental
Practice address
17700 San Pedro Ave
Suite 320
San Antonio, TX 78232-1404
Phone
(210) 495-6255
Fax
(210) 495-6260
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2016

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

Authorized official

Name
Dr. Marcus Ervin, DDS
Title
Owner
Phone
(210) 653-4867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 20569 TX Primary

Addresses

Primary practice location

17700 San Pedro Ave
Suite 320
San Antonio, TX 78232-1404

Mailing address

8415 Datapoint Dr
Suite 1020
San Antonio, TX 78229-3298
Phone (714) 578-6358

Other names 1

  • Castle Dental Doing business as

National Provider Directory

National Provider Directory

Locations

17700 San Pedro Ave
Ste 320
San Antonio, TX 78232
Phone (210) 495-6255

Practitioners & affiliated clinicians

Practitioners 4

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1720158496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 DATAPOINT DR",
            "address_2": "SUITE 1020",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293298",
            "telephone_number": "714-578-6358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17700 SAN PEDRO AVE",
            "address_2": "SUITE 320",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321404",
            "telephone_number": "210-495-6255",
            "fax_number": "210-495-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS SAN ANTONIO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-653-4867",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "20569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Castle Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.