NPIMap

Organization Active NPI

SP Administration

  • Dentist
  • San Antonio, TX
National Provider Identifier
1720526163
Registry record updated Feb 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
17028 Issued in TX
Legal business name
SP ADMINISTRATION
Practice address
6510 Babcock Rd
Suite 106
San Antonio, TX 78249
Phone
(210) 558-7000
Fax
(210) 558-7001
NPI assigned
Feb 6, 2017
Organization subpart
Yes
Parent organization
SOUTHPARK FAMILY DENTAL CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2017

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

Authorized official

Name
Dr. Shiva Izaddoust, D.D.S.
Title
Owner
Phone
(210) 927-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 17028 TX Primary

Addresses

Primary practice location

6510 Babcock Rd
Suite 106
San Antonio, TX 78249

Mailing address

6510 Babcock Rd
Suite # 106
San Antonio, TX 78249
Phone (210) 558-7000

Other identifiers 1

IdentifierTypeStateIssuer
136343411MedicaidTX

Other names 1

  • SPRINGTIME FAMILY DENTAL CARE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SP Administration3 organizations share this tax ID, including this one
Part of
SP Administration

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6510 Babcock Rd
Ste 106
San Antonio, TX 78249
Phone (210) 558-7000

Practitioners & affiliated clinicians

Practitioners 1

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": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1720526163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6510 BABCOCK RD",
            "address_2": "SUITE # 106",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78249",
            "telephone_number": "210-558-7000",
            "fax_number": "210-558-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6510 BABCOCK RD",
            "address_2": "SUITE 106",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78249",
            "telephone_number": "210-558-7000",
            "fax_number": "210-558-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SP ADMINISTRATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHPARK FAMILY DENTAL CARE",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "IZADDOUST",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-927-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "17028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136343411",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPRINGTIME FAMILY DENTAL CARE",
            "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 Feb 6, 2017; 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.