South Town Dental Care, Inc.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SOUTH TOWN DENTAL CARE, INC.

Practice address

10720 W Indian School Rd Ste 55
Phoenix, AZ 85037-5724

Phone

(623) 877-1729

NPI assigned

Feb 19, 2019

Organization subpart

No

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

Authorized official

Name

Tim J Wildung

Title

Ceo / Treasurer

Phone

(602) 391-4107

Specialties & licenses 1

Addresses

Other names 1

• Garden Lakes Family Dentistry Doing business as

Locations

Practitioners 2

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

• Erisa Sam, DMD

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1477177491
  NPD (past)
• Thomas Robert Walker, D.D.S.

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1609927375
  NPD (past)

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

{
    "created_epoch": "1550534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550534400000",
    "number": "1043776644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 E SOUTHERN AVE STE A-122",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092790",
            "telephone_number": "602-391-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10720 W INDIAN SCHOOL RD STE 55",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375724",
            "telephone_number": "623-877-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TOWN DENTAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-19",
        "last_updated": "2019-02-19",
        "status": "A",
        "authorized_official_last_name": "WILDUNG",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO / TREASURER",
        "authorized_official_telephone_number": "602-391-4107"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garden Lakes Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Mountain Rehabilitation P.C.
• South Mountain Surgery Center, LLC
• South Phoenix Integrity House LLC
• South Phoenix Prep and Arts Academy
• South Phoenix Veterans Group Home
• South Valley Prep and Arts School
• South West Rheumatology PC
• Jenasee Loretta South
• James Brian Southard, ATC
• Southeast X-Ray LLC

• Dental Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; 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.