3515 Sycamore School Rd PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

3515 SYCAMORE SCHOOL RD PLLC

Practice address

3515 Sycamore School Rd Ste 170
Fort Worth, TX 76133-7823

Phone

(817) 809-4860

NPI assigned

Oct 21, 2022

Organization subpart

No

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

Authorized official

Name

Gunjan Dhir, DDS

Title

Owner

Phone

(817) 809-4860

Specialties & licenses 1

Addresses

Other names 1

• Fresh Smiles of Fort Worth South Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1942927843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 E RANDOL MILL RD STE 520",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760116380",
            "telephone_number": "817-809-4860",
            "fax_number": "682-626-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 SYCAMORE SCHOOL RD STE 170",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761337823",
            "telephone_number": "817-809-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "3515 SYCAMORE SCHOOL RD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-21",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "DHIR",
        "authorized_official_first_name": "GUNJAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-809-4860",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@altiusdental.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3515 Sycamore School Rd Ste 170",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761337823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Fresh Smiles of Fort Worth South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.