NPIMap

Organization Active NPI

Arizona Dental Professionals, P.C.

Doing business as Roosevelt Commons Dental Care

  • Dentist
  • Buckeye, AZ
National Provider Identifier
1053296731
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ARIZONA DENTAL PROFESSIONALS, P.C.
Doing business as
Roosevelt Commons Dental Care
Practice address
860 N Verrado Way Ste 102
Buckeye, AZ 85326-7777
Phone
(480) 805-5840
NPI assigned
Aug 11, 2025
Last updated
Aug 11, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ARIZONA DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

860 N Verrado Way Ste 102
Buckeye, AZ 85326-7777

Mailing address

860 N Verrado Way Ste 102
Buckeye, AZ 85326-7777
Phone (480) 805-5840

Other names 1

  • Roosevelt Commons Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Detnal Care of Arizona PC63 organizations share this tax ID, including this one
Part of
Heartland Detnal Care of Arizona PC

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

860 N Verrado Way
Ste 102
Buckeye, AZ 85326
Phone (480) 805-5840

Ownership & related parties

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.

NPI Registry JSON

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

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1053296731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 N VERRADO WAY STE 102",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853267777",
            "telephone_number": "480-805-5840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 N VERRADO WAY STE 102",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853267777",
            "telephone_number": "480-805-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARIZONA DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2025-08-11",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-06",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roosevelt Commons Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buckeye, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.