NPIMap

Organization Active NPI

Evangelista Dental Care, PLLC

Doing business as Beyond Smiles Dental,Care

  • General Practice Dentistry
  • Fort Worth, TX
National Provider Identifier
1841591658
Registry record updated Nov 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
EVANGELISTA DENTAL CARE, PLLC
Doing business as
Beyond Smiles Dental,Care
Practice address
6600 North Fwy Ste 109
Fort Worth, TX 76137-7556
Phone
(817) 232-4600
Fax
(817) 232-4610
NPI assigned
Nov 10, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2010

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

Authorized official

Name
Dr. Edwina Jimenez Evangelista, DDSNPI 1992914758
Title
President
Phone
(817) 232-4600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

6600 North Fwy Ste 109
Fort Worth, TX 76137-7556

Mailing address

6600 North Fwy Ste 109
Fort Worth, TX 76137-7556
Phone (817) 232-4600

Other identifiers 1

IdentifierTypeStateIssuer
1992914758MedicaidTX

Other names 1

  • Beyond Smiles Dental,Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1289347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289347200000",
    "number": "1841591658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 NORTH FWY STE 109",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761377556",
            "telephone_number": "817-232-4600",
            "fax_number": "817-232-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 NORTH FWY STE 109",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761377556",
            "telephone_number": "817-232-4600",
            "fax_number": "817-232-4610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANGELISTA DENTAL CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-10",
        "last_updated": "2010-11-10",
        "status": "A",
        "authorized_official_last_name": "EVANGELISTA",
        "authorized_official_first_name": "EDWINA",
        "authorized_official_middle_name": "JIMENEZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-232-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992914758",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beyond Smiles Dental,Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.