NPIMap

Organization Active NPI

Children's Medicaid Dental Clinic, PC

Doing business as Children's Dental Clinic of W. Thomas Rd.

  • General Practice Dentistry
  • Phoenix, AZ
National Provider Identifier
1326025974
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CHILDREN'S MEDICAID DENTAL CLINIC, PC
Doing business as
Children's Dental Clinic of W. Thomas Rd.
Practice address
5115 W Thomas Rd
Phoenix, AZ 85031-3944
Phone
(602) 233-3133
Fax
(602) 278-3139
NPI assigned
Dec 26, 2005
Last updated
May 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2010

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

Authorized official

Name
Ms. Trudy Williams
Title
Director, Licensing & Credentialing
Phone
(615) 750-0342

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

5115 W Thomas Rd
Phoenix, AZ 85031-3944

Mailing address

201 W 8TH St
Suite 810
Pueblo, CO 81003-3038
Phone (719) 562-4447

Other identifiers 1

IdentifierTypeStateIssuer
619661MedicaidAZ

Other names 1

  • Children's Dental Clinic of W. Thomas Rd. Doing business as

National Provider Directory

National Provider Directory

Locations

5115 W Thomas Rd
Phoenix, AZ 85031
Phone (602) 233-3133

Practitioners & affiliated clinicians

Practitioners 4

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": "1135555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1326025974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W 8TH ST",
            "address_2": "SUITE 810",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033038",
            "telephone_number": "719-562-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850313944",
            "telephone_number": "602-233-3133",
            "fax_number": "602-278-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S MEDICAID DENTAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-26",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "TRUDY",
        "authorized_official_title_or_position": "DIRECTOR, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0342",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "619661",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Dental Clinic of W. Thomas Rd.",
            "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 May 17, 2010; 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.