Damon Duckworth

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

009961 Issued in AZ

Practice address

31129 N 117TH Dr
Peoria, AZ 85383-8282

Phone

(801) 842-6333

NPI assigned

Feb 8, 2015

Last updated

Mar 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Highbury Dental Management, LLC

  dba Island Pediatric Dentistry

  • Public Health Dentistry
  • Gilbert, AZ
  • NPI 1962091454
  NPD (past)

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

{
    "created_epoch": "1423353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1205227618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31129 N 117TH DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853838282",
            "telephone_number": "801-842-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31129 N 117TH DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853838282",
            "telephone_number": "801-842-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCKWORTH",
        "first_name": "DAMON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-08",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "009961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Drummond, FNP
• Jodie Drury
• Katrina Dryer, NP
• DT Dental, PLLC
• Duality Language Services LLC
• Amanda Jean Dudek, PT, DPT, ATC
• John Matthew Duff, D.C.
• Amber Denise Dugan, FNP-BC
• Jeane Marie Dumbrell, RN IBCLC
• Diana Duncan

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.