NPIMap

Organization Active NPI

Mill Avenue Family Dentistry PC

  • General Practice Dentistry
  • Tempe, AZ
National Provider Identifier
1245309640
Registry record updated Apr 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MILL AVENUE FAMILY DENTISTRY PC
Practice address
1712 E Guadalupe Rd
Suite 109
Tempe, AZ 85283-3983
Phone
(480) 829-8200
Fax
(480) 967-5252
NPI assigned
Nov 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2012

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

Authorized official

Name
Dr. Stacy Tracy, DDSNPI 1689631160
Title
President Co-Owner
Phone
(480) 829-8200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1712 E Guadalupe Rd
Suite 109
Tempe, AZ 85283-3983

Mailing address

1712 E Guadalupe Rd
Suite 109
Tempe, AZ 85283-3983
Phone (480) 829-8200

Other names 1

  • Tempe Smile Design Doing business as

National Provider Directory

National Provider Directory

Locations

1712 E Guadalupe Rd
Ste 109
Tempe, AZ 85283
Phone (480) 829-8200

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335398400000",
    "number": "1245309640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 E GUADALUPE RD",
            "address_2": "SUITE 109",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852833983",
            "telephone_number": "480-829-8200",
            "fax_number": "480-967-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 E GUADALUPE RD",
            "address_2": "SUITE 109",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852833983",
            "telephone_number": "480-829-8200",
            "fax_number": "480-967-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL AVENUE FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2012-04-26",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "PRESIDENT CO-OWNER",
        "authorized_official_telephone_number": "480-829-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tempe Smile Design",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.