Greenway 40 LLC

Primary specialty

DentistTaxonomy code 122300000X

License

AZ3740 Issued in AZ

Legal business name

GREENWAY 40 LLC

Doing business as

Age Defying Dentistry, Phoenix

Practice address

4022 E Greenway Rd
Ste 13
Phoenix, AZ 85032-4797

Phone

(602) 595-1115

NPI assigned

Jul 1, 2011

Last updated

Aug 2, 2012By 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. David J Velasco Jr., DDS

Title

Co-Owner

Phone

(602) 595-1115

Specialties & licenses 2

Addresses

Other names 1

• Age Defying Dentistry, Phoenix Doing business as

Locations

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343865600000",
    "number": "1174810840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4022 E GREENWAY RD",
            "address_2": "STE 13",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850324799",
            "telephone_number": "602-595-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4022 E GREENWAY RD",
            "address_2": "STE 13",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850324797",
            "telephone_number": "602-595-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWAY 40 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-01",
        "last_updated": "2012-08-02",
        "status": "A",
        "authorized_official_last_name": "VELASCO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "602-595-1115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "AZ4044",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "AZ3740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Age Defying Dentistry, Phoenix",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Laurence Greenspan, MD
• Greenstaff Medical Home Care LLC (Greenstaff Medical Staffing)
• Greenstaff Medical Staffing LLC
• Victoria Nicole Greenstein, MD
• Alan Robert Greenwald, MA, NCSP
• Greenway Backfit Medical Venture LLC
• Greenway Dental Lab Inc.
• Greenway Urgent Care LLC (NextCare)
• Greenwaysurgery Center LLC
• Michael N Greenwell, MSW, LCSW

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

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