NPIMap

Organization Active NPI

Arrowhead Lakes Dentistry P C

  • General Practice Dentistry
  • Glendale, AZ
National Provider Identifier
1154537884
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3505 Issued in AZ
Legal business name
ARROWHEAD LAKES DENTISTRY P C
Practice address
20265 N 59TH Ave
Suite B 5
Glendale, AZ 85308
Phone
(623) 362-9616
Fax
(623) 362-2614
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2012

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

Authorized official

Name
Dr. Ronald K Shelley, DMD MAGDNPI 1851487771
Title
Owner Doctor
Phone
(623) 362-9616

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 3505 AZ Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 4433 AZ
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5928 AZ

Addresses

Primary practice location

20265 N 59TH Ave
Suite B 5
Glendale, AZ 85308

Mailing address

20265 N 59TH Ave
Suite B 5
Glendale, AZ 85308
Phone (623) 362-9616

National Provider Directory

National Provider Directory

Locations

20265 N 59th Ave
Ste B5
Glendale, AZ 85308
Phone (623) 362-9616

Practitioners & affiliated clinicians

Practitioners 4

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": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1154537884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20265 N 59TH AVE",
            "address_2": "SUITE B 5",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-362-9616",
            "fax_number": "623-362-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20265 N 59TH AVE",
            "address_2": "SUITE B 5",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-362-9616",
            "fax_number": "623-362-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARROWHEAD LAKES DENTISTRY P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "SHELLEY",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "623-362-9616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MAGD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "3505",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "4433",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5928",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; 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.