NPIMap

Organization Active NPI

My Local Texas Dental Practice, PLLC

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1861069775
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Practice address
12521 Nacogdoches Rd Ste 103
San Antonio, TX 78217-2117
Phone
(210) 653-3452
NPI assigned
Jun 9, 2021
Organization subpart
Yes
Parent organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

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

Authorized official

Name
Michelle Johnson
Title
Credentialing Specialist
Phone
(509) 315-8338

Specialties & licenses 1

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

Addresses

Primary practice location

12521 Nacogdoches Rd Ste 103
San Antonio, TX 78217-2117

Mailing address

12521 Nacogdoches Rd Ste 103
San Antonio, TX 78217-2117

Other names 1

  • Premier Dental Center San Antonio II Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address premiersa2@peakdentalservices.com

National Provider Directory

National Provider Directory
Tax ID family
My Local Texas Dental Practice PLLC16 organizations share this tax ID, including this one
Part of
My Local Texas Dental Practice PLLC

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1861069775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12521 NACOGDOCHES RD STE 103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782172117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12521 NACOGDOCHES RD STE 103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782172117",
            "telephone_number": "210-653-3452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY LOCAL TEXAS DENTAL PRACTICE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MY LOCAL TEXAS DENTAL PRACTICE, PLLC",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "509-315-8338"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "premiersa2@peakdentalservices.com",
            "affiliation": "N",
            "address_1": "12521 Nacogdoches Rd Ste 103",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782172117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Premier Dental Center San Antonio II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.