Active NPI
Kathleen Ann Conderato, DDS
- Dentist
- Glendale, AZ
National Provider Identifier
1073668786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D008598
- Practice address
- 7700 W Arrowhead Towne Ctr
Glendale, AZ 85308-8616 - Phone
- (623) 937-6453
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D008598 | AZ | Primary |
Addresses
Primary practice location
7700 W Arrowhead Towne Ctr
Glendale, AZ 85308-8616
Mailing address
30840 N 42ND PL
Cave Creek, AZ 85331-5893
Phone (419) 564-5368
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073668786 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D008598 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386028800000",
"number": "1073668786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30840 N 42ND PL",
"city": "CAVE CREEK",
"state": "AZ",
"postal_code": "853315893",
"telephone_number": "419-564-5368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7700 W ARROWHEAD TOWNE CTR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088616",
"telephone_number": "623-937-6453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONDERATO",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2013-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D008598",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1073668786",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.