NPIMap

Organization Active NPI

Brivadental LLC

  • Clinic/Center
  • Peoria, AZ
National Provider Identifier
1043645765
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
D07658 Issued in AZ
Legal business name
BRIVADENTAL LLC
Practice address
13695 N 75TH Ave
Peoria, AZ 85381-6098
Phone
(602) 439-1101
Fax
(602) 789-1653
NPI assigned
Sep 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Authorized official

Name
Dr. Vasudha Narra, DDSNPI 1619120540
Title
Owner
Phone
(602) 439-1101

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X D07658 AZ Primary

Addresses

Primary practice location

13695 N 75TH Ave
Peoria, AZ 85381-6098

Mailing address

13695 N 75TH Ave
Peoria, AZ 85381-6098
Phone (602) 439-1101

Other names 1

  • AZ Cosmetic & Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

5757 W Thunderbird Rd
Ste W300
Glendale, AZ 85306
Phone (602) 439-1101

13695 N 75th Ave
Peoria, AZ 85381
Phone (602) 439-1101

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605139200000",
    "number": "1043645765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13695 N 75TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853816098",
            "telephone_number": "602-439-1101",
            "fax_number": "602-789-1653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13695 N 75TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853816098",
            "telephone_number": "602-439-1101",
            "fax_number": "602-789-1653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIVADENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-12",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "NARRA",
        "authorized_official_first_name": "VASUDHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-439-1101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": "D07658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AZ Cosmetic & Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AZ Cosmetic & Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.