NPIMap

Organization Active NPI

Cook Childrens Physician Network

Doing business as Cook Children's Dental

  • Pediatric Dentistry
  • Fort Worth, TX
National Provider Identifier
1841601291
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
COOK CHILDRENS PHYSICIAN NETWORK
Doing business as
Cook Children's Dental
Practice address
2600 E Berry Street
Fort Worth, TX 76105-4750
Phone
(817) 347-4600
Fax
(817) 347-4639
NPI assigned
May 19, 2014
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COOK CHILDRENS PHYSICIAN NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Matthew V Dzurik, MD
Title
President, CCPN
Phone
(682) 885-1416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X Primary

Addresses

Primary practice location

2600 E Berry Street
Fort Worth, TX 76105-4750

Mailing address

PO Box 732669
Dallas, TX 75373-2669
Phone (817) 347-4600

Other identifiers 1

IdentifierTypeStateIssuer
1404428A9OtherTXDE1

Other names 1

  • Cook Children's Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cook Childrens Phys Netwk5 organizations share this tax ID, including this one
Part of
Cook Childrens Phys Netwk

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1841601291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 732669",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753732669",
            "telephone_number": "817-347-4600",
            "fax_number": "817-347-4639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E BERRY STREET",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761054750",
            "telephone_number": "817-347-4600",
            "fax_number": "817-347-4639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK CHILDRENS PHYSICIAN NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOK CHILDRENS PHYSICIAN NETWORK",
        "enumeration_date": "2014-05-19",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "DZURIK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT, CCPN",
        "authorized_official_telephone_number": "682-885-1416",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DE1",
            "identifier": "1404428A9",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cook Children's Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cook Children's Dental",
            "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 Jun 29, 2021; 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.