NPIMap

Organization Active NPI

San Marcos Pediatric Dentistry and Orthodontics

  • Pediatric Dentistry
  • San Marcos, TX
National Provider Identifier
1750032504
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SAN MARCOS PEDIATRIC DENTISTRY AND ORTHODONTICS
Practice address
1330 Wonder World Dr Ste 103
San Marcos, TX 78666-7567
Phone
(512) 353-5500
Fax
(512) 353-1619
NPI assigned
Jan 13, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Authorized official

Name
Dr. Derek Leung, DMDNPI 1306228168
Title
Owner
Phone
(512) 353-5500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

1330 Wonder World Dr Ste 103
San Marcos, TX 78666-7567

Mailing address

1330 Wonder World Dr Ste 103
San Marcos, TX 78666-7567
Phone (512) 353-5500

Other names 1

  • San Marcos Pediatric Dentistry and Orthodontics Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sm@kidsdentalandbraces.com Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

1330 Wonder World Dr
Ste 103
San Marcos, TX 78666
Phone (512) 353-5500

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": "1642032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642032000000",
    "number": "1750032504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 WONDER WORLD DR STE 103",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786667567",
            "telephone_number": "512-353-5500",
            "fax_number": "512-353-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 WONDER WORLD DR STE 103",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786667567",
            "telephone_number": "512-353-5500",
            "fax_number": "512-353-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MARCOS PEDIATRIC DENTISTRY AND ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "LEUNG",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-353-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sm@kidsdentalandbraces.com",
            "affiliation": "N",
            "endpointDescription": "office email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1330 Wonder World Dr Ste 103",
            "city": "San Marcos",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786667567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "San Marcos Pediatric Dentistry and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Marcos, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; 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.