Northwest Dental Management, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13920 Issued in TX

Legal business name

NORTHWEST DENTAL MANAGEMENT, PA

Practice address

24200 W Ih 10
Suite 112
San Antonio, TX 78257-1145

Phone

(210) 687-1133

Fax

(210) 687-1132

NPI assigned

Jul 28, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Mary B Mellard, DDS

Title

President

Phone

(210) 687-1133

Specialties & licenses 1

Addresses

Other names 1

• Mary B. Mellard, DDS Doing business as

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269561600000",
    "number": "1841290137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24200 W IH 10",
            "address_2": "SUITE 112",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782571145",
            "telephone_number": "210-687-1133",
            "fax_number": "210-687-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24200 W IH 10",
            "address_2": "SUITE 112",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782571145",
            "telephone_number": "210-687-1133",
            "fax_number": "210-687-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST DENTAL MANAGEMENT, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2010-03-26",
        "status": "A",
        "authorized_official_last_name": "MELLARD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-687-1133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary B. Mellard, DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northside Family Counseling Center
• Northside Independent School District
• Northside Independent School District
• Northwest Anesthesiology Sa, P.a.
• Northwest Dental Center PLLC
• Northwest Pediatric Associates
• Northwest Residential Care
• Northwoods Dental Spa
• Christine Hilleary Norton, D.O.
• Denise Lee Norton, M.D.

• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; 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.