NPIMap

Organization Active NPI

Fabulous Smiles of Mesa

Doing business as Fabulous Smiles

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1245575398
Registry record updated Nov 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8358 Issued in AZ
Legal business name
FABULOUS SMILES OF MESA
Doing business as
Fabulous Smiles
Practice address
4434 E. Brown Rd
Ste 104
Mesa, AZ 85205
Phone
(480) 654-3000
Fax
(480) 654-0303
NPI assigned
Nov 30, 2012
Organization subpart
Yes
Parent organization
FABULOUS DENTAL MANAGEMENT, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2012

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

Authorized official

Name
Dr. Kevin Hyung Choi, DDSNPI 1003963398
Title
Manager
Phone
(480) 654-3000

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 8358 AZ Primary

Addresses

Primary practice location

4434 E. Brown Rd
Ste 104
Mesa, AZ 85205

Mailing address

4434 E. Brown Rd.
Ste 104
Mesa, AZ 85205
Phone (480) 654-3000

Other names 1

  • Fabulous Smiles Doing business as

National Provider Directory

National Provider Directory

Locations

4434 E Brown Rd
Ste 104
Mesa, AZ 85205
Phone (480) 654-3000

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": "1354233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354233600000",
    "number": "1245575398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4434 E. BROWN RD.",
            "address_2": "STE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85205",
            "telephone_number": "480-654-3000",
            "fax_number": "480-654-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4434 E. BROWN RD",
            "address_2": "STE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85205",
            "telephone_number": "480-654-3000",
            "fax_number": "480-654-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FABULOUS SMILES OF MESA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FABULOUS DENTAL MANAGEMENT, LLC",
        "enumeration_date": "2012-11-30",
        "last_updated": "2012-11-30",
        "status": "A",
        "authorized_official_last_name": "CHOI",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "HYUNG",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-654-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "8358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fabulous Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

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