Gulf Coast Pediatric Dental Specialists PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30734 Issued in TX

Legal business name

GULF COAST PEDIATRIC DENTAL SPECIALISTS PLLC

Doing business as

Gulf Coast Pediatric Dental Specialists

Practice address

6318 FM 1488 Rd Ste 120
Magnolia, TX 77354-2519

Phone

(281) 985-9075

Fax

(936) 448-9862

NPI assigned

Apr 27, 2016

Organization subpart

No

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

Authorized official

Name

Olamide Osundolu Atanda, DMD

Title

Owner

Phone

(352) 333-0909

Specialties & licenses 1

Addresses

Other names 1

• Gulf Coast Pediatric Dental Specialists Doing business as

Locations

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461715200000",
    "number": "1790130789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3121 BUFFALO SPEEDWAY APT 5307",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770981852",
            "telephone_number": "352-333-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6318 FM 1488 RD STE 120",
            "city": "MAGNOLIA",
            "state": "TX",
            "postal_code": "773542519",
            "telephone_number": "281-985-9075",
            "fax_number": "936-448-9862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PEDIATRIC DENTAL SPECIALISTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A",
        "authorized_official_last_name": "ATANDA",
        "authorized_official_first_name": "OLAMIDE",
        "authorized_official_middle_name": "OSUNDOLU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-333-0909",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "30734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Coast Pediatric Dental Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; 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.