Specialty Pediatric Dentistry, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SPECIALTY PEDIATRIC DENTISTRY, PC

Practice address

3313 Ranch Road 620 S Ste 300
Lakeway, TX 78738-6871

Phone

(512) 266-7200

Fax

(512) 233-5180

NPI assigned

Mar 30, 2023

Organization subpart

No

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

Authorized official

Name

Serenthes Fields

Title

Credentialing Specialist

Phone

(678) 599-2333

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1760186811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S A W GRIMES BLVD STE 190",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786647843",
            "telephone_number": "512-266-7200",
            "fax_number": "512-233-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3313 RANCH ROAD 620 S STE 300",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787386871",
            "telephone_number": "512-266-7200",
            "fax_number": "512-233-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-30",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "FIELDS",
        "authorized_official_first_name": "SERENTHES",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "678-599-2333"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett E Smith, D.P.M.
• Elizabeth Marie Smith, FNP-C
• Laurence Ryan Smith, D.C.
• Teresa Lambert Smith, DDS
• Gayle Holt Snowden, RN, BSN, CNOR
• Corina Stancey, MD
• Star State Heart PLLC
• Star State Heart, PLLC
• Grant Starey
• Nancy Ann Stehlik-Amador, O.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.