NPIMap

Organization Active NPI

Pediatric Dentistry of Keller PLLC

  • Pediatric Dentistry
  • Keller, TX
National Provider Identifier
1750934253
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PEDIATRIC DENTISTRY OF KELLER PLLC
Practice address
1627 Keller Parkway
Suite 100
Keller, TX 76248
Phone
(480) 207-9709
NPI assigned
Jul 23, 2019
Last updated
Jul 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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

Authorized official

Name
Jacob Johnson, DDSNPI 1093964900
Title
Member
Phone
(480) 207-9709

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

1627 Keller Parkway
Suite 100
Keller, TX 76248

Mailing address

2101 Bradley Dr
Keller, TX 76248-6868
Phone (480) 207-9709

National Provider Directory

National Provider Directory

Locations

1627 Keller Pkwy
Ste 100
Keller, TX 76248
Phone (480) 207-9709

Practitioners & affiliated clinicians

Practitioners 368

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.

View all 368

NPI Registry JSON

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563840000000",
    "number": "1750934253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 BRADLEY DR",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762486868",
            "telephone_number": "480-207-9709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 KELLER PARKWAY",
            "address_2": "SUITE 100",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "76248",
            "telephone_number": "480-207-9709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF KELLER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-23",
        "last_updated": "2019-07-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "480-207-9709",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keller, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; 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.