Hermosa Dental and Orthodontics Group LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5067 Issued in AZ

Legal business name

HERMOSA DENTAL AND ORTHODONTICS GROUP LLC

Practice address

3415 W Glendale Ave
30
Phoenix, AZ 85051-8386

Phone

(602) 242-0550

Fax

(602) 242-4965

NPI assigned

Dec 6, 2013

Last updated

Dec 6, 2013By 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

Mr. Rasoul Salim

Title

Owner

Phone

(602) 242-0550

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386288000000",
    "number": "1306277918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 W GLENDALE AVE",
            "address_2": "30",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850518386",
            "telephone_number": "602-242-0550",
            "fax_number": "602-242-4965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 W GLENDALE AVE",
            "address_2": "30",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850518386",
            "telephone_number": "602-242-0550",
            "fax_number": "602-242-4965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERMOSA DENTAL AND ORTHODONTICS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2013-12-06",
        "status": "A",
        "authorized_official_last_name": "SALIM",
        "authorized_official_first_name": "RASOUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-242-0550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D5067",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "D6876",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D8403",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "D8369",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan T Herman, MD
• Todd Christopher Herman, MD
• Ashley Hermes, MS, LAC
• Jeanette Marie Hermes, RD
• Anne M Hermida, MD
• Maria Zulema Hernandez Campos, RN
• Celina Hernandez Escobedo
• Vanessa Hernandez Montecillo
• Lytzy Hernandez-Gonzalez
• Jenny M Hernandez-Sanchez, LCSW

• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.