NPIMap

Organization Active NPI

KKTZ Dental PLLC

  • General Practice Dentistry
  • Fort Mohave, AZ
National Provider Identifier
1093288334
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KKTZ DENTAL PLLC
Practice address
5221 S Highway 95 Ste 4
Fort Mohave, AZ 86426-9244
Phone
(928) 577-2533
Fax
(928) 577-2518
NPI assigned
Jan 9, 2019
Organization subpart
Yes
Parent organization
KKTZ DENTAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Authorized official

Name
Gayle Jennings
Title
Office Manager
Phone
(928) 577-2533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

5221 S Highway 95 Ste 4
Fort Mohave, AZ 86426-9244

Mailing address

5221 S Highway 95 Ste 4
Fort Mohave, AZ 86426-9244
Phone (928) 577-2533

Other practice location 1

4601 N Stockton Hill Rd
Kingman, AZ 86409-1756
Phone (928) 757-3225

National Provider Directory

National Provider Directory
Tax ID family
KKTZ Dental PLLC3 organizations share this tax ID, including this one
Part of
KKTZ Dental PLLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1546992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1093288334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5221 S HIGHWAY 95 STE 4",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864269244",
            "telephone_number": "928-577-2533",
            "fax_number": "928-577-2518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5221 S HIGHWAY 95 STE 4",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864269244",
            "telephone_number": "928-577-2533",
            "fax_number": "928-577-2518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4601 N Stockton Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "864091756",
            "country_code": "US",
            "telephone_number": "928-757-3225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KKTZ DENTAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KKTZ DENTAL PLLC",
        "enumeration_date": "2019-01-09",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-577-2533"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mohave, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.