Active NPI
Kenedy Dental PLLC
- Dental Clinic/Center
- Kenedy, TX
National Provider Identifier
1962227371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- KENEDY DENTAL PLLC
- Practice address
- 131 Business Park Blvd Ste 600
Kenedy, TX 78119-3512 - Phone
- (972) 838-3772
- NPI assigned
- Nov 20, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Maxim M Mossman, DDS
- Title
- Ceo
- Phone
- (972) 838-3772
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Primary |
Addresses
Primary practice location
131 Business Park Blvd Ste 600
Kenedy, TX 78119-3512
Mailing address
PO Box 195487
Dallas, TX 75219-8608
Phone (972) 838-3772
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732060800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732060800000",
"number": "1962227371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 195487",
"city": "DALLAS",
"state": "TX",
"postal_code": "752198608",
"telephone_number": "972-838-3772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 BUSINESS PARK BLVD STE 600",
"city": "KENEDY",
"state": "TX",
"postal_code": "781193512",
"telephone_number": "972-838-3772"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KENEDY DENTAL PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-11-20",
"last_updated": "2024-11-20",
"certification_date": "2024-11-20",
"status": "A",
"authorized_official_last_name": "MOSSMAN",
"authorized_official_first_name": "MAXIM",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "972-838-3772",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenedy, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.