NPIMap

Organization Active NPI

Katsur Dental of Arizona, Inc.

Doing business as Katsur Dental of Arizona

  • General Practice Dentistry
  • Goodyear, AZ
National Provider Identifier
1174771612
Registry record updated Nov 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5216 Issued in AZ
Legal business name
KATSUR DENTAL OF ARIZONA, INC.
Doing business as
Katsur Dental of Arizona
Practice address
105 N Litchfield Rd
Goodyear, AZ 85338-1617
Phone
(623) 932-3200
Fax
(623) 932-3222
NPI assigned
Sep 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2010

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

Authorized official

Name
Terri Gardiner
Title
Credentialing Coordinator
Phone
(407) 772-5124

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5795 AZ
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5216 AZ Primary

Addresses

Primary practice location

105 N Litchfield Rd
Goodyear, AZ 85338-1617

Mailing address

926 Great Pond Dr
Suite 5000
Altamonte Springs, FL 32714-7244
Phone (407) 772-5124

Other identifiers 7

IdentifierTypeStateIssuer
565806OtherAZSANTORO AHCCCS#
294311OtherAZLOAN KIM DAO AHCCCS#
197645OtherAZONET AHCCCS#
506058OtherAZTURNER AHCCCS#
368780OtherAZGROUP AHCCCS#
561921OtherAZWHATCOTT AHCCCS#
774457OtherAZSKAALEN AHCCCS#

Other names 1

  • Katsur Dental of Arizona Doing business as

National Provider Directory

National Provider Directory

Locations

926 Great Pond Dr
Ste 5000
Altamonte Springs, FL 32714

Practitioners & affiliated clinicians

Practitioners 6

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": "1220832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1174771612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 GREAT POND DR",
            "address_2": "SUITE 5000",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327147244",
            "telephone_number": "407-772-5124",
            "fax_number": "407-788-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N LITCHFIELD RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381617",
            "telephone_number": "623-932-3200",
            "fax_number": "623-932-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATSUR DENTAL OF ARIZONA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-08",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "GARDINER",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "407-772-5124"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5795",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANTORO AHCCCS#",
            "identifier": "565806",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOAN KIM DAO AHCCCS#",
            "identifier": "294311",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONET AHCCCS#",
            "identifier": "197645",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TURNER AHCCCS#",
            "identifier": "506058",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP AHCCCS#",
            "identifier": "368780",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WHATCOTT AHCCCS#",
            "identifier": "561921",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SKAALEN AHCCCS#",
            "identifier": "774457",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Katsur Dental of Arizona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.