NPIMap

Organization Active NPI

Cottonwood Modern Dentistry, LLP

Doing business as Cottonwood Modern Dentistry

  • Dentist
  • Cottonwood, AZ
National Provider Identifier
1295163558
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
COTTONWOOD MODERN DENTISTRY, LLP
Doing business as
Cottonwood Modern Dentistry
Practice address
1061 S Highway 260
Cottonwood, AZ 86326-4624
Phone
(928) 472-8000
Fax
(928) 472-8001
NPI assigned
Oct 24, 2013
Last updated
Aug 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Authorized official

Name
Dr. Carl C Fairchild, DDS
Title
Owner Doctor
Phone
(928) 472-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

1061 S Highway 260
Cottonwood, AZ 86326-4624

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • Cottonwood Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1061 S State Route 260
Cottonwood, AZ 86326
Phone (928) 239-3254

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": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1295163558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 S HIGHWAY 260",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264624",
            "telephone_number": "928-472-8000",
            "fax_number": "928-472-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTONWOOD MODERN DENTISTRY, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "FAIRCHILD",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "928-472-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottonwood Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cottonwood Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cottonwood, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.