NPIMap

Organization Active NPI

Vallecillo & Menna Dentistry, P.C.

Doing business as Mona Lisa Dental

  • General Practice Dentistry
  • Gilbert, AZ
National Provider Identifier
1023015914
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5778 Issued in AZ
Legal business name
VALLECILLO & MENNA DENTISTRY, P.C.
Doing business as
Mona Lisa Dental
Practice address
936 E Williams Field Rd
Suite 101
Gilbert, AZ 85296-4881
Phone
(480) 722-7600
Fax
(480) 722-0111
NPI assigned
Jul 7, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carlos Alberto Vallecillo III, DDSNPI 1134268873
Title
President
Phone
(480) 722-7600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 5778 AZ Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 5876 AZ

Addresses

Primary practice location

936 E Williams Field Rd
Suite 101
Gilbert, AZ 85296-4881

Mailing address

936 E Williams Field Rd
Suite 101
Gilbert, AZ 85296-4881
Phone (480) 722-7600

Other names 1

  • Mona Lisa Dental Doing business as

National Provider Directory

National Provider Directory

Locations

936 E Williams Field Rd
Ste 101
Gilbert, AZ 85295
Phone (480) 722-7600

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023015914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 E WILLIAMS FIELD RD",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964881",
            "telephone_number": "480-722-7600",
            "fax_number": "480-722-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "936 E WILLIAMS FIELD RD",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964881",
            "telephone_number": "480-722-7600",
            "fax_number": "480-722-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLECILLO & MENNA DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VALLECILLO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "ALBERTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-722-7600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5778",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5876",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mona Lisa Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.