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BROAD PARK DENTAL PA
NPI 1083849707
Dentist - General Practice in Mansfield, TX

Active since May 26, 2009
1750 E BROAD ST, MANSFIELD, TX 76063(817) 473-6857(817) 473-3256 Get Directions Write a Review

NPPES record last updated: May 26, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Broad Park Dental Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROAD PARK DENTAL PA (NPI 1083849707) is a healthcare organization registered as a general practice in Mansfield, Texas and active in the NPI registry since May 2009. The organization lists Jeremy Israel Rudd, Owner, as its authorized official.

NPPES Registry Identity

NPI1083849707
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameBROAD PARK DENTAL PA
Location Address1750 E BROAD STMansfield, TX 76063-3400
Mailing Address1750 E Broad StMansfield, TX 76063-3400 · (817) 473-6857 · Fax (817) 473-3256
Phone(817) 473-6857
Fax(817) 473-3256
Organization SubpartNo
Authorized OfficialJeremy Israel RuddOwner · (817) 473-6857
Enumeration DateMay 26, 2009
✔ NPI 1083849707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in TX · 22486
Definition
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.
1750 E BROAD ST, Mansfield, TX 76063
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SHANNA HOWZE DDS
Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063
Tarrant County (817) 473-6857
DR. JEREMY I RUDD D.M.D.
Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063
Tarrant County (817) 473-6857
BROAD PARK FAMILY DENTISTRY
Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063
Tarrant County (817) 473-6857
ALYSA BROOKE SADKIN DMD
Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063
Tarrant County (817) 473-6857

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Broad Park Dental PA's NPI number?

The NPI number for Broad Park Dental PA is 1083849707. It was assigned to this organization in the NPPES registry on May 26, 2009.

Where is Broad Park Dental PA located?

Broad Park Dental PA is located at 1750 E Broad St, Mansfield, TX 76063. The listed phone number is (817) 473-6857.

What is Broad Park Dental PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Broad Park Dental PA was last updated on May 26, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.