Surprise Pediatric Dentistry, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D008930 Issued in AZ

Legal business name

SURPRISE PEDIATRIC DENTISTRY, PC

Practice address

15331 W Bell Rd
Suite #112
Surprise, AZ 85374-4102

Phone

(602) 730-6481

Fax

(602) 730-6482

NPI assigned

Dec 23, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Mathew O Jensen, DMD

Title

Dentist/Owner

Phone

(801) 656-7978

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew O. Jensen, DMD

  • Pediatric Dentistry
  • Surprise, AZ
  • NPI 1982703427
  NPD (past)

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

{
    "created_epoch": "1482451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482451200000",
    "number": "1114462330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15331 W BELL RD",
            "address_2": "SUITE #112",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853744102",
            "telephone_number": "602-730-6481",
            "fax_number": "602-730-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15331 W BELL RD",
            "address_2": "SUITE #112",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853744102",
            "telephone_number": "602-730-6481",
            "fax_number": "602-730-6482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURPRISE PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-23",
        "last_updated": "2016-12-23",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "801-656-7978",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "D008930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200173",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Surprise Medical LLC
• Surprise Memory Care, LP
• Surprise Modern Dentistry LLP
• Surprise Optometric Care
• Surprise Pain and Spine
• Surprise Pediatrics
• Surprise Residential Assisted Living
• Surprise Smiles of Beauty PC
• Surprise Smiles PLLC
• Surprise Speech Therapy

• Dental Clinic/Center in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2016; 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.