Beaumont Smiles Youth Dentistry, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BEAUMONT SMILES YOUTH DENTISTRY, PLLC

Practice address

3865 Phelan Blvd
Beaumont, TX 77707-2243

Phone

(409) 833-5497

Fax

(409) 833-5441

NPI assigned

May 10, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Jenell Stump

Title

Manager, Licensing & Credentialing

Phone

(615) 750-0343

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1982818498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3865 PHELAN BLVD",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777072243",
            "telephone_number": "409-833-5497",
            "fax_number": "409-833-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUMONT SMILES YOUTH DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184854101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beaumont Psychological Services PC
• Beaumont Radiology Group, LLP
• Beaumont Recovery and Consulting, Inc.
• Beaumont Retina Consultant PA
• Beaumont Smile Center, P.a.
• Beaumont SNF LLC (The Oasis at Beaumont)
• Beaumont Speech and Language LLC
• Beaumont Spine Associates
• Beaumont Spine Pain and Sports Medicince
• Beaumont Surgical Affiliates, LTD (Baptist Beaumont Surgical Affiliates)

• General Practice Dentistry in Beaumont, TX
• Providers in Beaumont, 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 9, 2014; 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.