NPIMap

Organization Active NPI

Thomas S Durisek, DDS, PC

Doing business as Open Wide Dental

  • Dental Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1295919751
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
4777 Issued in AZ
Legal business name
THOMAS S DURISEK, DDS, PC
Doing business as
Open Wide Dental
Practice address
6520 N 7TH Ave
Suite #1
Phoenix, AZ 85013-1158
Phone
(602) 347-9999
NPI assigned
Dec 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Authorized official

Name
Thomas Scott Durisek, DDSNPI 1467585257
Title
President
Phone
(602) 347-9999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 4777 AZ Primary

Addresses

Primary practice location

6520 N 7TH Ave
Suite #1
Phoenix, AZ 85013-1158

Mailing address

6520 N 7TH Ave
Suite #1
Phoenix, AZ 85013-1158

Other names 1

  • Open Wide Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Geishun Management Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

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": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1295919751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 N 7TH AVE",
            "address_2": "SUITE #1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 N 7TH AVE",
            "address_2": "SUITE #1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131158",
            "telephone_number": "602-347-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS S DURISEK, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "DURISEK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-347-9999",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "4777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Open Wide Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.