Identity Dental Specialties

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

IDENTITY DENTAL SPECIALTIES

Practice address

18325 N Allied Way Ste 115
Phoenix, AZ 85054-3107

Phone

(480) 661-4867

Fax

(480) 661-1266

NPI assigned

Feb 4, 2026

Last updated

Feb 4, 2026By 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

Mariyana Pavlova

Title

Ceo, President

Phone

(480) 661-4867

Specialties & licenses 1

Addresses

Locations

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.

• Jennifer Hicks, DMD

  • Dentist
  • Goodyear, AZ
  • NPI 1992544068
  NPD (past)

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

{
    "created_epoch": "1770163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1275484495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18325 N ALLIED WAY STE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850543107",
            "telephone_number": "480-661-4867",
            "fax_number": "480-661-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18325 N ALLIED WAY STE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850543107",
            "telephone_number": "480-661-4867",
            "fax_number": "480-661-1266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTITY DENTAL SPECIALTIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-04",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "PAVLOVA",
        "authorized_official_first_name": "MARIYANA",
        "authorized_official_title_or_position": "CEO, PRESIDENT",
        "authorized_official_telephone_number": "480-661-4867"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Davis Ide, MD
• Ideal Care LLC
• Ideal Physical Therapy
• Ideal Self LLC
• Ideal Treatment Center LLC
• Identity Hormones LLC
• Osahon Nekpen Idolor, MD
• Samer Imad Idriss, DO
• Alexandra Carolina Idrovo, MD
• Ids Dental Services PLLC

• Dental Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; 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.