Marana Pediatric Dentistry, Tyler Roberts, DMD, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MARANA PEDIATRIC DENTISTRY, TYLER ROBERTS, DMD, PLLC

Doing business as

Little Rebelz Pediatric Dentistry

Practice address

6239 E Brown Rd Ste 102
Mesa, AZ 85205-4933

Phone

(480) 753-3711

NPI assigned

Feb 29, 2024

Last updated

May 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tyler Roberts, DMDNPI 1982850459

Title

Dentist

Phone

(401) 536-5087

Specialties & licenses 1

Addresses

Other names 1

• Little Rebelz Pediatric Dentistry Doing business as

Practitioners 1

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.

• Tyler Roberts, DDS

  • Pediatric Dentistry
  • Casa Grande, AZ
  • NPI 1982850459
  NPD Authorized official

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

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1174380836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2165 N DORAN",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852032081",
            "telephone_number": "401-536-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6239 E BROWN RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054933",
            "telephone_number": "480-753-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANA PEDIATRIC DENTISTRY, TYLER ROBERTS, DMD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "401-536-5087",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Rebelz Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Little Rebelz Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Alexander Manwill
• Philip M Manzano, MD
• Gabrielle Nader Mapes-Alhout
• Emily Elizabeth Maples, OTR/L
• Debbie G. Marack, LMSW
• Maranatha Anesthesia, PLLC
• Marc Community Resources, Inc
• Marc Community Resources, Inc
• Marc Community Resources, Inc.
• Marc Community Resources, Inc.

• Pediatric Dentistry in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.