Scottsdale Implant and Cosmetic Dentistry LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D009808 Issued in AZ

Legal business name

SCOTTSDALE IMPLANT AND COSMETIC DENTISTRY LLC

Practice address

4910 E Greenway Rd Ste 7
Scottsdale, AZ 85254-1653

Phone

(480) 200-3453

NPI assigned

Apr 13, 2018

Organization subpart

Yes

Parent organization

VALLEY IMPLANT CENTERS PLLCAs reported in NPPES

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

Authorized official

Name

Mrs. Portia L Fredstrup

Title

Owner

Phone

(602) 303-5827

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Scottsdale Implant and Cosmetic Dentistry Doing business as

Part of

Valley Implant Centers

Locations

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.

• Valley Implant Centers

  • Dental Clinic/Center
  • Chandler, AZ
  • NPI 1841760899
  NPPES parent name

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

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1134616378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7547 S FRONTIER ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852980130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 E GREENWAY RD STE 7",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852541653",
            "telephone_number": "480-200-3453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTTSDALE IMPLANT AND COSMETIC DENTISTRY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VALLEY IMPLANT CENTERS PLLC",
        "enumeration_date": "2018-04-13",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "FREDSTRUP",
        "authorized_official_first_name": "PORTIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-303-5827",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "D009808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1457874901",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Scottsdale Implant and Cosmetic Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Scottsdale, AZ
• Providers in Scottsdale, 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 Jun 16, 2018; 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.