NPIMap

Organization Active NPI

East Scottsdale Pediatric Dental, PC

  • Dental Clinic/Center
  • Scottsdale, AZ
National Provider Identifier
1073982997
Registry record updated Oct 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D009209 Issued in AZ
Legal business name
EAST SCOTTSDALE PEDIATRIC DENTAL, PC
Practice address
12020 E Shea Blvd
Ste 8
Scottsdale, AZ 85259-4179
Phone
(480) 767-5600
NPI assigned
Sep 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2015

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

Authorized official

Name
Dr. Candace H Veneberg, D.D.SNPI 1619073814
Title
Director
Phone
(501) 850-5110

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
Dental Clinic/Center 261QD0000X D009209 AZ Primary

Addresses

Primary practice location

12020 E Shea Blvd
Ste 8
Scottsdale, AZ 85259-4179

Mailing address

12020 E Shea Blvd
Ste 8
Scottsdale, AZ 85259-4179
Phone (480) 767-5600

Other identifiers 1

IdentifierTypeStateIssuer
064282MedicaidAZ

Other names 1

  • Dental Associates For Kids Only Doing business as

National Provider Directory

National Provider Directory

Locations

12020 E Shea Blvd
Ste 8
Scottsdale, AZ 85259
Phone (480) 767-5600

Practitioners & affiliated clinicians

Practitioners 3

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": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445126400000",
    "number": "1073982997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12020 E SHEA BLVD",
            "address_2": "STE 8",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852594179",
            "telephone_number": "480-767-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12020 E SHEA BLVD",
            "address_2": "STE 8",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852594179",
            "telephone_number": "480-767-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST SCOTTSDALE PEDIATRIC DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2015-10-18",
        "status": "A",
        "authorized_official_last_name": "VENEBERG",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "501-850-5110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "D009209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064282",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Associates For Kids Only",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2015; 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.