Broadmoor SRG PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

BROADMOOR SRG PLLC

Practice address

500 N Galloway Ave Ste 6
Mesquite, TX 75149-4338

Phone

(214) 493-1216

NPI assigned

Mar 31, 2022

Organization subpart

No

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

Authorized official

Name

Nina Abtahi

Title

Manager

Phone

(214) 493-1216

Specialties & licenses 2

Addresses

Other names 1

• Smile Heroes Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy Ryan Mooney, D.D.S.

  • General Practice Dentistry
  • Dallas, TX
  • NPI 1710338702
  NPD

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

{
    "created_epoch": "1648684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1831839455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N GALLOWAY AVE STE 6",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751494338",
            "telephone_number": "214-493-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N GALLOWAY AVE STE 6",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751494338",
            "telephone_number": "214-493-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADMOOR SRG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-31",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "ABTAHI",
        "authorized_official_first_name": "NINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "214-493-1216"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Heroes Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smile Heroes Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; 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.