Imagine Dental

Primary specialty

DentistTaxonomy code 122300000X

License

D07028 Issued in AZ

Legal business name

IMAGINE DENTAL

Practice address

650 W Maryland Ave
1-2
Phoenix, AZ 85013-1399

Phone

(480) 633-9977

NPI assigned

Jun 10, 2014

Organization subpart

Yes

Parent organization

DENTAL SPECIALTY ASSOCIATESAs reported in NPPES

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

Authorized official

Name

Dr. Brian Lilien, DDS

Title

Owner

Phone

(480) 633-9977

Specialties & licenses 1

Addresses

Tax ID family

Dental Specialty Associates2 organizations share this tax ID, including this one

Part of

Dental Specialty Associates

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dental Specialty Associates

  • Multi-Specialty Clinic/Center
  • Gilbert, AZ
  • NPI 1114180320
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Dental Specialty Associates

  • Multi-Specialty Clinic/Center
  • Gilbert, AZ
  • NPI 1114180320
  NPPES parent name

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1043623770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W MARYLAND AVE",
            "address_2": "1-2",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W MARYLAND AVE",
            "address_2": "1-2",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131399",
            "telephone_number": "480-633-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL SPECIALTY ASSOCIATES",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "LILIEN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-633-9977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D07028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Phoenix, AZ
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; 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.