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: July 19, 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
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

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


The following 4 providers are registered at the same or a nearby location.

Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063
Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063
Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063
Dentist (General Practice)
1750 E BROAD ST
MANSFIELD, TX 76063

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1083849707, enumerated as an "organization" on May 26, 2009.

The provider is located at 1750 E BROAD ST MANSFIELD, TX 76063 and the phone number is (817) 473-6857.

Dentist with taxonomy code 1223G0001X and a focus in General Practice.