Aqua Dental of Texas PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AQUA DENTAL OF TEXAS PLLC

Practice address

307 E Camp Wisdom Rd
Suite 305
Duncanville, TX 75116-2705

Phone

(310) 923-3787

NPI assigned

Oct 27, 2010

Last updated

Oct 27, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Harishpal Virk

Title

Managing Member

Phone

(310) 923-3787

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1851691539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E CAMP WISDOM RD",
            "address_2": "SUITE 305",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751162705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E CAMP WISDOM RD",
            "address_2": "SUITE 305",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751162705",
            "telephone_number": "310-923-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUA DENTAL OF TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A",
        "authorized_official_last_name": "VIRK",
        "authorized_official_first_name": "HARISHPAL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "310-923-3787"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.