NPIMap

Organization Active NPI

Laveen Modern Dentistry

  • Dentist
  • Laveen, AZ
National Provider Identifier
1154856177
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9657 Issued in AZ
Legal business name
LAVEEN MODERN DENTISTRY
Practice address
5045 W Baseline Rd Ste 135
Laveen, AZ 85339-7394
Phone
(602) 237-0613
NPI assigned
Apr 27, 2017
Last updated
Apr 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

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

Authorized official

Name
Dr. Amanda Girardi, D.M.D.
Title
Dentist
Phone
(209) 481-2544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 9657 AZ Primary

Addresses

Primary practice location

5045 W Baseline Rd Ste 135
Laveen, AZ 85339-7394

Mailing address

3036 W Mohawk LN
Phoenix, AZ 85027-3117

National Provider Directory

National Provider Directory
Tax ID family
Amanda Girardi5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1154856177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3036 W MOHAWK LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5045 W BASELINE RD STE 135",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853397394",
            "telephone_number": "602-237-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVEEN MODERN DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-27",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "GIRARDI",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "209-481-2544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "9657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laveen, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; 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.