2133 Pepperrell St Bldg 3352, Jbsa Lackland, TX 78236
Phone
(210) 292-8627
Listed under
Individual orthodontists
NPI
1104815042
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Orthodontics and Dentofacial Orthopedics (1223X0400X)
Credentials listed
DDS
License number on NPI record
17074 (TX)
NPI first issued
Oct 13, 2005
NPI record last updated
Aug 21, 2019
NPI 1104815042 is active in the federal NPPES registry (CMS) with Orthodontics and Dentofacial Orthopedics, an ADA-recognized dental specialty, as its primary taxonomy; license 17074 (TX) 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. Orthodontists are dentists who completed an accredited orthodontic residency after dental school. General dentists can also offer braces or aligners, but they are not listed here.
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 Orthodontics lists board-certified orthodontists.