Fort Worth Smilebar PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FORT WORTH SMILEBAR PLLC

Doing business as

Smile Ninja Dental

Practice address

550 Alta Mere Dr
Fort Worth, TX 76114-4053

Phone

(817) 286-0044

NPI assigned

Feb 13, 2020

Last updated

Feb 13, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

SMILE NINJA, PLLCAs reported in NPPES

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

Authorized official

Name

Justin D Mund, DDSNPI 1851527741

Title

Owner

Phone

(817) 916-4431

Specialties & licenses 3

Addresses

Other names 1

• Smile Ninja Dental Doing business as

Part of

Smile Ninja PLLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Smile Ninja, PLLC

  • General Practice Dentistry
  • Fort Worth, TX
  • NPI 1871002261
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Justin Dain Mund, DDS

  • General Practice Dentistry
  • Fort Worth, TX
  • NPI 1851527741
  NPD Authorized official

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1740813195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 E SEMINARY DR STE 100",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761152653",
            "telephone_number": "817-916-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 ALTA MERE DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761144053",
            "telephone_number": "817-286-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH SMILEBAR PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMILE NINJA, PLLC",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "MUND",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-916-4431",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Ninja Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Fort Worth, TX
• Providers in Fort Worth, 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 Feb 13, 2020; 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.