Phoenix Mountain Dentistry, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

D5983 Issued in AZ

Legal business name

PHOENIX MOUNTAIN DENTISTRY, LLC

Practice address

4155 N 108TH Ave Ste 101
Phoenix, AZ 85037-5464

Phone

(623) 877-4044

Fax

(623) 877-0058

NPI assigned

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Fawne Pryor

Title

Ar and Insurance Manager

Phone

(602) 944-0073

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295850808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 W MESCAL ST STE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294764",
            "telephone_number": "602-944-0073",
            "fax_number": "602-944-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 N 108TH AVE STE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375464",
            "telephone_number": "623-877-4044",
            "fax_number": "623-877-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX MOUNTAIN DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRYOR",
        "authorized_official_first_name": "FAWNE",
        "authorized_official_title_or_position": "AR AND INSURANCE MANAGER",
        "authorized_official_telephone_number": "602-944-0073",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D5983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phoenix Medical Psychiatric Hospital, LLC
• Phoenix Medical Solutions LLC
• Phoenix Mental Health and Wellness PLLC
• Phoenix Metabolic Health PLLC
• Phoenix Mind Body Connection LLC
• Phoenix Mountain Nursing Center Inc
• Phoenix Mountain Nursing Center, Inc.
• Phoenix Mountain Pkwy Medical Center, LLC
• Phoenix Mua Physicians Group
• Phoenix Neurological Associates LTD

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.