Family Dental Phoenix

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

FAMILY DENTAL PHOENIX

Practice address

2401 W Glendale Ave Ste 102
Phoenix, AZ 85021-7621

Phone

(602) 864-1119

NPI assigned

Jul 30, 2020

Organization subpart

No

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

Authorized official

Name

Marvin Blane Jackson, DDS

Title

DDS

Phone

(435) 637-2100

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1205445749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W GLENDALE AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850217621",
            "telephone_number": "602-864-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W GLENDALE AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850217621",
            "telephone_number": "602-864-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL PHOENIX",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "BLANE",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "435-637-2100",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "586868",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@familydentalphx.com",
            "affiliation": "N",
            "address_1": "2401 W Glendale Ave Ste 102",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850217621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Family Care Physicians
• Family Christian Counseling Center of Phoenix
• Family Comfort Home Health, LLC
• Family Comfort Hospice Care Inc
• Family Dental at Moon Valley
• Family Dental Phoenix
• Family Doula Services LLC
• Family First Assisted Living Dba Golden Life
• Family First Hospice Inc
• Family First Vision Care Arizona PLLC

• Dental Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.