NPIMap

Organization Active NPI

Maryland Avenue Periodontics, LLC

  • Periodontics
  • Phoenix, AZ
National Provider Identifier
1053602953
Registry record updated Apr 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
MARYLAND AVENUE PERIODONTICS, LLC
Practice address
6520 N 7TH Ave Ste 5
Phoenix, AZ 85013-1158
Phone
(602) 242-2588
Fax
(602) 242-3137
NPI assigned
Apr 26, 2011
Last updated
Apr 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2011

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

Authorized official

Name
Jennifer Warner
Title
Office Manager
Phone
(602) 242-2588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X Primary

Addresses

Primary practice location

6520 N 7TH Ave Ste 5
Phoenix, AZ 85013-1158

Mailing address

6520 N 7TH Ave Ste 5
Phoenix, AZ 85013-1158
Phone (602) 242-2588

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303776000000",
    "number": "1053602953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 N 7TH AVE STE 5",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131158",
            "telephone_number": "602-242-2588",
            "fax_number": "602-242-3137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 N 7TH AVE STE 5",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131158",
            "telephone_number": "602-242-2588",
            "fax_number": "602-242-3137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND AVENUE PERIODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-26",
        "last_updated": "2011-04-26",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "602-242-2588"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; 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.