East Valley Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

2619 Issued in AZ

Legal business name

EAST VALLEY PERIODONTICS

Practice address

6755 E Superstition Springs Blvd
Ste. 102
Mesa, AZ 85206-4373

Phone

(480) 218-7590

Fax

(480) 218-2247

NPI assigned

Jun 16, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Penny Sue McKinney

Title

Office Manager

Phone

(480) 218-7590

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1063649192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6755 E SUPERSTITION SPRINGS BLVD",
            "address_2": "STE. 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064373",
            "telephone_number": "480-218-7590",
            "fax_number": "480-218-2247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6755 E SUPERSTITION SPRINGS BLVD",
            "address_2": "STE. 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064373",
            "telephone_number": "480-218-7590",
            "fax_number": "480-218-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-16",
        "last_updated": "2009-06-16",
        "status": "A",
        "authorized_official_last_name": "MCKINNEY",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "480-218-7590",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "2619",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "7751",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; 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.