NPIMap

Organization Active NPI

Evans/Koen Main St Dental PLLC

Doing business as Main Street Dental

  • Dental Clinic/Center
  • Buda, TX
National Provider Identifier
1770193070
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
EVANS/KOEN MAIN ST DENTAL PLLC
Doing business as
Main Street Dental
Practice address
108 S Main St
Buda, TX 78610-3375
Phone
(512) 295-9925
NPI assigned
Aug 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Authorized official

Name
Dr. Justin Dexter Koen, DMDNPI 1679651194
Title
Partner
Phone
(512) 295-9925

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

108 S Main St
Buda, TX 78610-3375

Mailing address

108 S Main St
Buda, TX 78610-3375
Phone (512) 295-9925

Other names 1

  • Main Street Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1596412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1770193070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 S MAIN ST",
            "city": "BUDA",
            "state": "TX",
            "postal_code": "786103375",
            "telephone_number": "512-295-9925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 S MAIN ST",
            "city": "BUDA",
            "state": "TX",
            "postal_code": "786103375",
            "telephone_number": "512-295-9925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS/KOEN MAIN ST DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "KOEN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "DEXTER",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "512-295-9925",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buda, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.