Kingman Family Dental Group LLC

Key facts

NPI

1235955592

Entity type

Organization (NPI type 2)

Primary specialty

Dental Clinic/Center 261QD0000X

Legal business name

KINGMAN FAMILY DENTAL GROUP LLC

Practice address

1751 N Stockton Hill Rd Ste a
Kingman, AZ 86401-6601

Phone

(928) 718-8668

NPI assigned

Dec 2, 2024

Organization subpart

No

Authorized official

Name

Mercedes Figueroa

Title

Credentialing Specialist

Phone

(623) 289-3392

National Provider Directory

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 2, 2024.

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1235955592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19601 N BLACK CANYON HWY # 201",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274107",
            "telephone_number": "623-289-3392",
            "fax_number": "623-289-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 N STOCKTON HILL RD STE A",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864016601",
            "telephone_number": "928-718-8668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGMAN FAMILY DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-02",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA",
        "authorized_official_first_name": "MERCEDES",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "623-289-3392"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Kingman",
            "affiliation": "N",
            "endpointDescription": "City",
            "address_1": "1751 N Stockton Hill Rd Ste A",
            "city": "Kingman",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "864016601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kingman, AZ

• Kingman Cancer Center
• Kingman Chiropractic Clinic PC
• Kingman Dental Group
• Kingman Dental Professionals, LLC
• Kingman Emergency Associates PLLC
• Kingman Family Dentistry
• Kingman Family Practice, P.C.
• Kingman General Surgery PC
• Kingman Healthcare, Inc
• Kingman Healthcare, Inc

All providers in Kingman, AZ · Dental Clinic/Center in Arizona