NPIMap

Organization Active NPI

Thunderbird Dental Management LLC

Doing business as Plaza Dental

  • General Practice Dentistry
  • Peoria, AZ
National Provider Identifier
1275084501
Registry record updated Oct 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D009244 Issued in AZ
Legal business name
THUNDERBIRD DENTAL MANAGEMENT LLC
Doing business as
Plaza Dental
Practice address
9145 W Thunderbird Rd
Suite H-105
Peoria, AZ 85381-4820
Phone
(623) 979-7477
NPI assigned
Oct 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2016

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

Authorized official

Name
Mr. Tim Wildung
Title
Owner
Phone
(480) 634-4803

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D009244 AZ Primary

Addresses

Primary practice location

9145 W Thunderbird Rd
Suite H-105
Peoria, AZ 85381-4820

Mailing address

9145 W Thunderbird Rd
Suite H-105
Peoria, AZ 85381-4820
Phone (623) 979-7477

Other names 1

  • Plaza Dental Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477008000000",
    "number": "1275084501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9145 W THUNDERBIRD RD",
            "address_2": "SUITE H-105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814820",
            "telephone_number": "623-979-7477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9145 W THUNDERBIRD RD",
            "address_2": "SUITE H-105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814820",
            "telephone_number": "623-979-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THUNDERBIRD DENTAL MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-21",
        "last_updated": "2016-10-21",
        "status": "A",
        "authorized_official_last_name": "WILDUNG",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-634-4803",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D009244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plaza Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; 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.