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, NPI 1003811100

Dentist in SOUTHLAKE, TX

Last Updated on : Dec 15,2014

 , NPI 1003811100

About (NPI 1003811100)


is a Dentist in SOUTHLAKE, United States with a focus in General Practice .

1003811100 is NPI number of .

's primary taxonomy code based on NPI Lookup is 1223G0001X with license number TX11540. This taxonomy code refers to Dentist.

current practice location address is 3101 E STATE HIGHWAY 114, SOUTHLAKE, TX. can be reached out via phone at 817-481-6364 and via fax at 817-329-2296 .

You can also correspond with through mail at mailing address 3101 E STATE HIGHWAY 114, SOUTHLAKE, TX, United States. Mailing address contact number is 817-481-6364.

The enumeration date of is 15-Jun-2005. The provider is registered as an Organization and the NPI record was last updated 10 years ago.

The authorized official of is JOHN TATE (Secretary). JOHN TATE can be reached at 8174816364.

1003811100 NPI Information

Basic NPI information of (NPI 1003811100) is provided below.

Name
National Provider Id (NPI) 1003811100
Entity Type Organization
Practice Address 3101 E STATE HIGHWAY 114, STE A
SOUTHLAKE, TX, United States
Practice Telephone 817-481-6364
Practice Fax Number 817-329-2296
Mailing Address 3101 E STATE HIGHWAY 114 , STE A
SOUTHLAKE, TX, United States
Mailing Telephone 817-481-6364
Mailing Fax Number 817-329-2296
Enumeration Date 15-Jun-2005
Last Updated Date 15-Dec-2014

(NPI 1003811100) Primary Taxonomy Information

The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs, the license data is associated to the taxonomy code.

Primary Taxonomy Code Clasification License Number License State
Y 1223G0001X Dentist, General Practice TX11540 TX

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional Identifiers

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type/Code Identifier State Identifier Issuer
TX11540 Other (non-Medicare) (01) TX Dental License Number
TX26565 Other (non-Medicare) (01) TX Dental License Number

(NPI 1003811100) Office Location

Office location of is provided in the Google maps below.

Providers in same location

Here are a few of the other providers in the same location.

NPI Name Taxonomy Address Enumeration date
1922735141 100 CHIRO PRINCE PLLC Chiropractor 8809 COPPER RIVER DR,
FORT WORTH, TX, United States
07-Aug-2022
1780110833 108 STEPHENVILLE EMERGENCY CARE Clinic/Center, Emergency Care 920 S KIMBALL AVE, 140
SOUTHLAKE, TX, United States
11-May-2017
1467067686 15140 NARSAN ER PHYSICIAN PLLC Emergency Medicine 15140 NACOGDOCHES RD,
SAN ANTONIO, TX, United States
14-Sep-2020
1972118198 1551 W CENTRAL ER PHYSICIANS PLLC Emergency Medicine 910 S KIMBALL AVE,
SOUTHLAKE, TX, United States
14-Sep-2020
1548556624 180 WELLNESS, LLP Chiropractor 321 W. SOUTHLAKE BLVD, STE 100
SOUTHLAKE, TX, United States
27-Jun-2011
1932629987 20/20 ICARE AND IWEAR, PLLC Optometrist 3510 S STATE HWY 161, SUITE 110
GRAND PRAIRIE, TX, United States
21-Jun-2017
1770093643 2013 BROADWAY EMERGENCY CARE LLC Clinic/Center, Emergency Care PO BOX 93082,
SOUTHLAKE, TX, United States
05-Oct-2017
1255841011 2013 PEARL ER PHYSICIANS PLLC Emergency Medicine, Emergency Medical Services PO BOX 93044,
SOUTHLAKE, TX, United States
06-Oct-2017
1992223085 2017 FWUC MEDICAL PROFESSIONALS PLLC Family Medicine 601 NORTHWEST PKWY STE C,
AZLE, TX, United States
08-Sep-2017
1942754700 2020 EYEDR Optometrist 1505 STONE DR,
CARROLLTON, TX, United States
10-Aug-2016
1760673164 21ST CENTURY LIVING CENTERS Intermediate Care Facility, Intellectual Disabilities 2695 LONESOME DOVE RD,
SOUTHLAKE, TX, United States
09-Aug-2007
1740603422 22250 BULVERDE CEC FOSSIL CREEK LLC Clinic/Center, Emergency Care 22250 BULVERDE RD, 120
SAN ANTONIO, TX, United States
30-Jan-2014
1316507510 24-7 AIR EVAC, INC. Ambulance, Air Transport PO BOX 55,
WATSONTOWN, PA, United States
19-Jun-2019
1801555784 360 CARDIAC CARE PC Internal Medicine, Interventional Cardiology 517 BOULDER DR,
SOUTHLAKE, TX, United States
08-Dec-2021
1780197574 4642 N MESA ER PHYSICIANS PLLC Emergency Medicine, Emergency Medical Services 4642 N MESA ST.,
EL PASO, TX, United States
15-Nov-2017
1134728892 7007 INDIANA ER PHYSICIANS PLLC Emergency Medicine 7007 INDIANA AVE,
LUBBOCK, TX, United States
22-Oct-2020
1417490848 A MILE OF COMFORT LLC Hospice Care, Community Based 771 E SOUTHLAKE BLVD, 209
SOUTHLAKE, TX, United States
03-Dec-2016
1114488327 A1B HEALTHCARE Family Medicine 771 E SOUTHLAKE BLVD,
SOUTHLAKE, TX, United States
29-Mar-2019
1235502972 GINA LYN LANE AALUND Social Worker, Clinical 2150 LAKESIDE BLVD, 225E
RICHARDSON, TX, United States
03-Nov-2015
1265977631 AARON C EUBANKS MD PA Orthopaedic Surgery 261 W SOUTHLAKE BLVD,
SOUTHLAKE, TX, United States
21-Dec-2016

How to check whether NPI 1063496693 is valid?

The following video explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

FAQs

Whose NPI Number is 1003811100?

1003811100 is the NPI number of .

Where is located?

is located at 3101 E STATE HIGHWAY 114, SOUTHLAKE, TX.

NPI number meaning

Field Name Field Value
NPI 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Mailing Address The mailing address of the provider being identified contains First line, Second Line, City name, State name, Postal code, and Country code.
Provider Business Mailing Address Telephone Number The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider Business Practice Location Address Telephone Number The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number The fax number associated with the location address of the provider being identified.
Provider Enumeration Date The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date The date that a record was last updated or changed.
Authorized Official Telephone Number The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy Taxonomy Description of the Healthcare Provider.
Provider License Number Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
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