Desert Ridge Oral,Facial & Implant Surgery, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D6337 Issued in AZ

Legal business name

DESERT RIDGE ORAL,FACIAL & IMPLANT SURGERY, PLLC

Practice address

20950 N Tatum Blvd
Suite 120
Phoenix, AZ 85050-4200

Phone

(480) 563-3960

NPI assigned

Sep 20, 2013

Last updated

Sep 20, 2013By 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. Brian Dorfman, DMD, MD

Title

Owner

Phone

(480) 563-3960

Specialties & licenses 1

Addresses

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.

• Matthew Adam Defelice, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Phoenix, AZ
  • NPI 1013914696
  NPD (past)

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

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379635200000",
    "number": "1215363320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20950 N TATUM BLVD",
            "address_2": "SUITE 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20950 N TATUM BLVD",
            "address_2": "SUITE 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504200",
            "telephone_number": "480-563-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT RIDGE ORAL,FACIAL & IMPLANT SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-20",
        "last_updated": "2013-09-20",
        "status": "A",
        "authorized_official_last_name": "DORFMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-563-3960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D6337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desert Ridge Gastroenterology
• Desert Ridge Implant & Oral Surgery PC
• Desert Ridge Medical Group
• Desert Ridge Medical Group Anesthesia LLC
• Desert Ridge Medical LLC
• Desert Ridge Outpatient Surgery LLC
• Desert Ridge Pain Facility
• Desert Ridge Pediatric Dentistry
• Desert Ridge Prosthodontics
• Desert Ridge Surgical Specialists, LLC

• Oral and Maxillofacial Surgery (Dentist) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; 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.