NPIMap

Organization Active NPI

Mogollon Family Dentistry

  • General Practice Dentistry
  • Overgaard, AZ
National Provider Identifier
1164344834
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MOGOLLON FAMILY DENTISTRY
Practice address
3367 Buckskin Rd # 100
Overgaard, AZ 85933
Phone
(928) 535-5886
Fax
(928) 535-5887
NPI assigned
Jul 27, 2026
Last updated
Jul 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

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

Authorized official

Name
Jeffrey Andersen, DO
Title
Dentist/ Owner
Phone
(928) 535-5886

Specialties & licenses 1

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

Addresses

Primary practice location

3367 Buckskin Rd # 100
Overgaard, AZ 85933

Mailing address

PO Box 100
Overgaard, AZ 85933-0100
Phone (928) 535-5886

National Provider Directory

National Provider Directory
Tax ID family
Mogollon Family Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1785110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785110400000",
    "number": "1164344834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "OVERGAARD",
            "state": "AZ",
            "postal_code": "859330100",
            "telephone_number": "928-535-5886",
            "fax_number": "928-535-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3367 BUCKSKIN RD # 100",
            "city": "OVERGAARD",
            "state": "AZ",
            "postal_code": "85933",
            "telephone_number": "928-535-5886",
            "fax_number": "928-535-5887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOGOLLON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-27",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "DENTIST/ OWNER",
        "authorized_official_telephone_number": "928-535-5886",
        "authorized_official_credential": "DO"
    },
    "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 Overgaard, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; 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.