Active NPI
Rajeev Misra, D.D.S.
- General Practice Dentistry
- Southlake, TX
National Provider Identifier
1881929552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17859
- Practice address
- 840 Simmons Court
Southlake, TX 76092 - Phone
- (817) 909-1023
- Fax
- (817) 488-9685
- NPI assigned
- Oct 13, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17859 | TX | Primary |
Addresses
Primary practice location
840 Simmons Court
Southlake, TX 76092
Mailing address
2140 E. Southlake Blvd
Suite L-509
Southlake, TX 76092
Phone (817) 909-1023
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17859 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255392000000",
"number": "1881929552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2140 E. SOUTHLAKE BLVD",
"address_2": "SUITE L-509",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "76092",
"telephone_number": "817-909-1023",
"fax_number": "817-488-9685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 SIMMONS COURT",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "76092",
"telephone_number": "817-909-1023",
"fax_number": "817-488-9685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISRA",
"first_name": "RAJEEV",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-13",
"last_updated": "2009-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "17859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.