Cleburne Dental Studio PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

29792 Issued in TX

Legal business name

CLEBURNE DENTAL STUDIO PLLC

Practice address

1607 W Henderson St Ste K
Cleburne, TX 76033-4179

Phone

(817) 522-3166

NPI assigned

Jul 18, 2017

Organization subpart

No

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

Authorized official

Name

Jin Park, DMDNPI 1992017461

Title

Owner Dentist

Phone

(817) 522-3166

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jin Woo Park, DMD

  • Dentist
  • Cleburne, TX
  • NPI 1992017461
  NPD Authorized official

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952824468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 W HENDERSON ST STE K",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760334179",
            "telephone_number": "817-522-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 W HENDERSON ST STE K",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760334179",
            "telephone_number": "817-522-3166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 Harmony Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Grapevine",
            "state": "TX",
            "postal_code": "760511134",
            "country_code": "US",
            "telephone_number": "267-210-2725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLEBURNE DENTAL STUDIO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-18",
        "last_updated": "2022-07-21",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JIN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "817-522-3166",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "29792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3427577",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CKCW Holdings, LLC
• Clearfork Cleburne LLC
• Cleburne Anesthesia PLLC
• Cleburne Birthing Center
• Cleburne Cancer Center LTD
• Cleburne Digestive Health PLLC
• Cleburne Drug Inc
• Cleburne Drug Inc
• Cleburne Drug Inc
• Cleburne Endoscopy Center, LLC

• General Practice Dentistry in Cleburne, TX
• Providers in Cleburne, 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 Jul 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.