Northeast Dallas Dental Associates, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28984 Issued in TX

Legal business name

NORTHEAST DALLAS DENTAL ASSOCIATES, PLLC

Doing business as

Pine Cove Dental

Practice address

1560 E Debbie LN Ste 108
Mansfield, TX 76063-8575

Phone

(817) 453-8520

NPI assigned

Jan 18, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Levy T DO, DDSNPI 1982992723

Title

President

Phone

(405) 633-3396

Specialties & licenses 1

Addresses

Other names 1

• Pine Cove Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Levy T DO, D.D.S.

  • General Practice Dentistry
  • Mansfield, TX
  • NPI 1982992723
  NPD (past) Authorized official

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516665600000",
    "number": "1932566213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E DEBBIE LN STE 108",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638575",
            "telephone_number": "817-453-8520",
            "fax_number": "817-453-8522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 E DEBBIE LN STE 108",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638575",
            "telephone_number": "817-453-8520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DALLAS DENTAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-18",
        "last_updated": "2018-01-23",
        "status": "A",
        "authorized_official_last_name": "DO",
        "authorized_official_first_name": "LEVY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-633-3396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Cove Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pine Cove Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dora Iyare Nomamiukor, NPN-C
• Jill Nonnemacher, LCSW
• Ghazal Norouzifar, PHARMD
• North Star Abdominopelvic Physical Therapy, LLC
• North Texas Urgent Care, P.a. (Expedian Urgent Care)
• Sara Christine Northrop, D.O
• Wallace B Norton, M.D.
• Susan Elizabeth Novell, MSN, FNP-C
• Eunice Onyinye Nsofor, PMHNP
• Lula Abdulkadir Nur

• General Practice Dentistry in Mansfield, TX
• Providers in Mansfield, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; 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.