Active NPI
Mavis Ho Park, DDS
- Dentist
- Fort Cavazos, TX
National Provider Identifier
1902526262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 38980
- Practice address
- 36000 Darnall Loop
Fort Cavazos, TX 76544-5095 - Phone
- (631) 742-9838
- NPI assigned
- Aug 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 38980 | TX | Primary |
Addresses
Primary practice location
36000 Darnall Loop
Fort Cavazos, TX 76544-5095
Mailing address
33001 Battalion Ave,
Fort Cavazos, TX 76544
Phone (254) 553-7186
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 |
|---|---|---|---|
| 38980 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724889600000",
"number": "1902526262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33001 BATTALION AVE,",
"city": "FORT CAVAZOS",
"state": "TX",
"postal_code": "76544",
"telephone_number": "254-553-7186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36000 DARNALL LOOP",
"city": "FORT CAVAZOS",
"state": "TX",
"postal_code": "765445095",
"telephone_number": "631-742-9838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MAVIS",
"middle_name": "HO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-29",
"last_updated": "2024-08-29",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "TX",
"license": "38980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Cavazos, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.