NPIMap

Organization Active NPI

Port Lavaca Dentistry PLLC

  • Dentist
  • Port Lavaca, TX
National Provider Identifier
1881005296
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
27025 Issued in TX
Legal business name
PORT LAVACA DENTISTRY PLLC
Practice address
1606 N Virginia St
Port Lavaca, TX 77979
Phone
(361) 552-5800
Fax
(888) 276-1646
NPI assigned
May 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Authorized official

Name
Paola Lopez
Title
Payer Enrollment Team Lead
Phone
(972) 869-3789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 27025 TX Primary

Addresses

Primary practice location

1606 N Virginia St
Port Lavaca, TX 77979

Mailing address

Attn: Credentialing
2403 Lacy Lane
Carrollton, TX 75006
Phone (972) 869-3789

National Provider Directory

National Provider Directory

Locations

1606 N Virginia St
Port Lavaca, TX 77979
Phone (361) 552-5800

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764806400000",
    "number": "1881005296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ATTN: CREDENTIALING",
            "address_2": "2403 LACY LANE",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "75006",
            "telephone_number": "972-869-3789",
            "fax_number": "888-276-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "77979",
            "telephone_number": "361-552-5800",
            "fax_number": "888-276-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT LAVACA DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-20",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "PAOLA",
        "authorized_official_title_or_position": "PAYER ENROLLMENT TEAM LEAD",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "27025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Lavaca, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; 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.