Individual provider Active NPI

Pooja Patel, DMD

  • General Practice Dentistry
  • Peoria, AZ
National Provider Identifier
1053645036
Registry record updated May 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D7891 Issued in AZ
Practice address
9163 W Union Hills Dr Ste 101
Peoria, AZ 85382-8187
Phone
(623) 680-2460
NPI assigned
Sep 24, 2009
Last updated
May 24, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D7891 AZ Primary

Addresses

Primary practice location

9163 W Union Hills Dr Ste 101
Peoria, AZ 85382-8187

Mailing address

9163 W Union Hills Dr Ste 101
Peoria, AZ 85382-8187
Phone (623) 680-2460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161112000424 AZ Order and Referring Only - Other (Non-Physician) 9032498126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D7891AZMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1253750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464048000000",
    "number": "1053645036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9163 W UNION HILLS DR STE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853828187",
            "telephone_number": "623-680-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9163 W UNION HILLS DR STE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853828187",
            "telephone_number": "623-680-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "POOJA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-24",
        "last_updated": "2016-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D7891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.