Waco Grins Pediatric Dentistry, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

21649 Issued in TX

Legal business name

WACO GRINS PEDIATRIC DENTISTRY, PLLC

Practice address

1605 Lake Success Dr
Waco, TX 76710-2908

Phone

(254) 772-4184

Fax

(254) 776-8391

NPI assigned

Aug 30, 2015

Last updated

Aug 30, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Keith Rice, D.D.S.

Title

Dentist

Phone

(254) 772-4184

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1440892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440892800000",
    "number": "1720455306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 LAKE SUCCESS DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102908",
            "telephone_number": "254-772-4184",
            "fax_number": "254-776-8391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 LAKE SUCCESS DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102908",
            "telephone_number": "254-772-4184",
            "fax_number": "254-776-8391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACO GRINS PEDIATRIC DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-30",
        "last_updated": "2015-08-30",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "254-772-4184",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "21649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Waco, TX
• Providers in Waco, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2015; 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.