NPIMap

Organization Active NPI

Desert Family Dental

  • Dentist
  • Mesa, AZ
National Provider Identifier
1295163418
Registry record updated Oct 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7570 Issued in AZ
Legal business name
DESERT FAMILY DENTAL
Practice address
1911 W Main St
#6
Mesa, AZ 85201-6929
Phone
(480) 838-4185
Fax
(480) 838-8746
NPI assigned
Oct 25, 2013
Last updated
Oct 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2013

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

Authorized official

Name
Scott Ryan Lee, DDSNPI 1427213172
Title
Owner
Phone
(480) 838-4185

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 7570 AZ Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 8303 AZ

Addresses

Primary practice location

1911 W Main St
#6
Mesa, AZ 85201-6929

Mailing address

1911 W Main St
#6
Mesa, AZ 85201-6929
Phone (480) 838-4185

Other identifiers 2

IdentifierTypeStateIssuer
1427213172OtherAZDENTIST
1003195413OtherAZDENTIST

National Provider Directory

National Provider Directory

Locations

1911 W Main St
Ste 6
Mesa, AZ 85201
Phone (480) 838-4185

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382659200000",
    "number": "1295163418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 W MAIN ST",
            "address_2": "#6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852016929",
            "telephone_number": "480-838-4185",
            "fax_number": "480-838-8746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 W MAIN ST",
            "address_2": "#6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852016929",
            "telephone_number": "480-838-4185",
            "fax_number": "480-838-8746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-25",
        "last_updated": "2013-10-25",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-838-4185",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "7570",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "8303",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "1427213172",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "1003195413",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 25, 2013; 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.