NPIMap

Organization Active NPI

Queen Creek Pediatric Dentistry LLC

  • Pediatric Dentistry
  • Gilbert, AZ
National Provider Identifier
1063618916
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5179 Issued in AZ
Legal business name
QUEEN CREEK PEDIATRIC DENTISTRY LLC
Practice address
7400 S Power Rd
BLDG 6, Ste 132
Gilbert, AZ 85297
Phone
(480) 503-3764
Fax
(480) 380-0336
NPI assigned
Jun 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Joel R ClarkNPI 1790759439
Title
Dentist
Phone
(480) 503-3764

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
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 5179 AZ Primary

Addresses

Primary practice location

7400 S Power Rd
BLDG 6, Ste 132
Gilbert, AZ 85297

Mailing address

7400 S Power Rd
BLDG 6, Ste 132
Gilbert, AZ 85297
Phone (480) 503-3764

Other names 1

  • A to Z Pediatric Dentistry Other name

National Provider Directory

National Provider Directory

Locations

7400 S Power Rd
Ste 132
Gilbert, AZ 85297
Phone (480) 503-3764

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063618916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 S POWER RD",
            "address_2": "BLDG 6, STE 132",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85297",
            "telephone_number": "480-503-3764",
            "fax_number": "480-380-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 S POWER RD",
            "address_2": "BLDG 6, STE 132",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85297",
            "telephone_number": "480-503-3764",
            "fax_number": "480-380-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN CREEK PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "480-503-3764",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "5179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A to Z Pediatric Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.