NPIMap

Organization Active NPI

Excellent Dental PC

  • General Practice Dentistry
  • Decatur, TX
National Provider Identifier
1811046527
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12614 Issued in TX
Legal business name
EXCELLENT DENTAL PC
Practice address
1101 W Eagle Dr Ste a
Decatur, TX 76234-3721
Phone
(940) 627-2778
Fax
(940) 627-7104
NPI assigned
Jan 10, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Cheryl H Renfro
Title
Business Administrator
Phone
(940) 627-2778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12614 TX Primary

Addresses

Primary practice location

1101 W Eagle Dr Ste a
Decatur, TX 76234-3721

Mailing address

1101 W Eagle Dr Ste a
Decatur, TX 76234-3721
Phone (940) 627-2778

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811046527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 W EAGLE DR STE A",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343721",
            "telephone_number": "940-627-2778",
            "fax_number": "940-627-7104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W EAGLE DR STE A",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343721",
            "telephone_number": "940-627-2778",
            "fax_number": "940-627-7104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLENT DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RENFRO",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "940-627-2778",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "12614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.