4900 Overton Ridge Blvd Ste 213, Fort Worth, TX 76132
Phone
(210) 844-9300
Listed under
Periodontists
NPI
1528738655
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Periodontics (1223P0300X)
Credentials listed
DDS
License number on NPI record
40411 (TN)
NPI first issued
Sep 20, 2021
NPI record last updated
Aug 28, 2024
NPI 1528738655 is active in the federal NPPES registry (CMS) with Periodontics, an ADA-recognized dental specialty, as its primary taxonomy; license 40411 (TN) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Periodontists specialize in the gums and bone that support the teeth, including placing implants, gum and bone grafting, and treating gum disease. Dentists who are not specialists can also place implants; the specialty here is the one the provider registered as primary.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Prosthodontics, the American Board of Oral and Maxillofacial Surgery and the American Board of Periodontology each list their board-certified members.