NPIMap

Organization Active NPI

Fairy & Tooth PLLC

  • Pediatric Dentistry
  • Richmond, TX
National Provider Identifier
1962162115
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
FAIRY & TOOTH PLLC
Practice address
25230 FM 1093 Rd Ste C
Richmond, TX 77406-2805
Phone
(832) 930-0060
NPI assigned
Dec 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Authorized official

Name
Dr. Dzhuliya ServetnikNPI 1235668021
Title
Owner
Phone
(832) 930-0060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

25230 FM 1093 Rd Ste C
Richmond, TX 77406-2805

Mailing address

2507 Eason LN
Houston, TX 77008-2964

Other names 1

  • Cavity Patrol Pediatric Dentistry - Katy Doing business as

National Provider Directory

National Provider Directory

Locations

25230 FM 1093 Rd
Ste C
Richmond, TX 77406
Phone (832) 930-0060

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1640649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1962162115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 EASON LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770082964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25230 FM 1093 RD STE C",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774062805",
            "telephone_number": "832-930-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRY & TOOTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-28",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "SERVETNIK",
        "authorized_official_first_name": "DZHULIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-930-0060",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cavity Patrol Pediatric Dentistry - Katy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.