NPIMap

Organization Active NPI

Scottsdale Dental Group, PLC

  • Dental Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1083264154
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SCOTTSDALE DENTAL GROUP, PLC
Practice address
4444 N 32ND St Ste 100
Phoenix, AZ 85018-3956
Phone
(602) 612-2262
Fax
(602) 581-3344
NPI assigned
Sep 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Authorized official

Name
Dr. Jennifer Terese Ebner, DDS, MS
Title
Owner/Dentist
Phone
(602) 612-2262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

4444 N 32ND St Ste 100
Phoenix, AZ 85018-3956

Mailing address

4444 N 32ND St Ste 100
Phoenix, AZ 85018-3956
Phone (602) 612-2262

Other identifiers 1

IdentifierTypeStateIssuer
626192MedicaidAZ

Other names 1

  • Biltmore Innovative Dentistry Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568851200000",
    "number": "1083264154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 N 32ND ST STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183956",
            "telephone_number": "602-612-2262",
            "fax_number": "602-581-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 N 32ND ST STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183956",
            "telephone_number": "602-612-2262",
            "fax_number": "602-581-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTTSDALE DENTAL GROUP, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-19",
        "last_updated": "2019-09-19",
        "status": "A",
        "authorized_official_last_name": "EBNER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "TERESE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "602-612-2262",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626192",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Biltmore Innovative Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; 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.