NPIMap

Organization Active NPI

Rodeo Weslaco Dental & Orthodontics

  • Dentist
  • Weslaco, TX
National Provider Identifier
1881079267
Registry record updated Jul 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
23066 Issued in TX
Legal business name
RODEO WESLACO DENTAL & ORTHODONTICS
Practice address
1901 W Expressway 83
800
Weslaco, TX 78596-4374
Phone
(817) 529-8151
Fax
(817) 529-8156
NPI assigned
Jul 27, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2015

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

Authorized official

Name
Raffy Kouyoumdjian
Title
Owner
Phone
(817) 529-8151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 23066 TX Primary

Addresses

Primary practice location

1901 W Expressway 83
800
Weslaco, TX 78596-4374

Mailing address

1901 W Expressway 83
800
Weslaco, TX 78596-4374

Other identifiers 7

IdentifierTypeStateIssuer
182419515MedicaidTX
182419514MedicaidTX
182419510MedicaidTX
182419517MedicaidTX
182419511MedicaidTX
182419513MedicaidTX
182419516MedicaidTX

National Provider Directory

National Provider Directory

Locations

1901 W Expressway 83
Ste 800
Weslaco, TX 78596
Phone (956) 277-2413

NPI Registry JSON

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

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437955200000",
    "number": "1881079267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 W EXPRESSWAY 83",
            "address_2": "800",
            "city": "WESLACO",
            "state": "TX",
            "postal_code": "785964374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W EXPRESSWAY 83",
            "address_2": "800",
            "city": "WESLACO",
            "state": "TX",
            "postal_code": "785964374",
            "telephone_number": "817-529-8151",
            "fax_number": "817-529-8156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODEO WESLACO DENTAL & ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-27",
        "last_updated": "2015-07-27",
        "status": "A",
        "authorized_official_last_name": "KOUYOUMDJIAN",
        "authorized_official_first_name": "RAFFY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-529-8151"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "23066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419515",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419514",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419510",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419517",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419511",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419513",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419516",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weslaco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; 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.