NPIMap

Organization Active NPI

Yuma Dental LLC

  • Preferred Provider Organization
  • Yuma, AZ
National Provider Identifier
1043652910
Registry record updated Jul 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
7892 Issued in AZ
Legal business name
YUMA DENTAL LLC
Practice address
2540 S 4TH Ave
Yuma, AZ 85364-7286
Phone
(928) 344-5700
NPI assigned
Jul 22, 2013
Last updated
Jul 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2013

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

Authorized official

Name
Dr. Justin Church, DMDNPI 1184857419
Title
Owner
Phone
(480) 206-0139

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
Preferred Provider Organization 305R00000X 7892 AZ Primary

Addresses

Primary practice location

2540 S 4TH Ave
Yuma, AZ 85364-7286

Mailing address

2540 S 4TH Ave
Yuma, AZ 85364-7286
Phone (928) 344-5700

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1374451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374451200000",
    "number": "1043652910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 S 4TH AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647286",
            "telephone_number": "928-344-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 S 4TH AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647286",
            "telephone_number": "928-344-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YUMA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-22",
        "last_updated": "2013-07-22",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-206-0139",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "AZ",
            "license": "7892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; 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.