Cedar Dental Group, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6399 Issued in AZ

Legal business name

CEDAR DENTAL GROUP, PC

Doing business as

M & C Community Dental Care

Practice address

333 E Virginia Ave
Suite 115
Phoenix, AZ 85004-1206

Phone

(602) 307-5775

Fax

(602) 307-9041

NPI assigned

Mar 3, 2010

Organization subpart

No

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

Authorized official

Name

George R Ayoub, DDS

Title

Dentist

Phone

(602) 307-5775

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• M & C Community Dental Care Doing business as

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

{
    "created_epoch": "1267574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267574400000",
    "number": "1073836110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 E VIRGINIA AVE",
            "address_2": "SUITE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041206",
            "telephone_number": "602-307-5775",
            "fax_number": "602-307-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 E VIRGINIA AVE",
            "address_2": "SUITE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041206",
            "telephone_number": "602-307-5775",
            "fax_number": "602-307-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-03",
        "last_updated": "2010-03-03",
        "status": "A",
        "authorized_official_last_name": "AYOUB",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "602-307-5775",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "6399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER NUMBER",
            "identifier": "951500",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M & C Community Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2010; 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.