NPIMap

Organization Active NPI

Pediatric Dental Specialists, PPC

  • Pediatric Dentistry
  • Gilbert, AZ
National Provider Identifier
1336146745
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PEDIATRIC DENTAL SPECIALISTS, PPC
Practice address
2550 E Guadalupe Rd
Suite 101
Gilbert, AZ 85234-5114
Phone
(480) 558-0777
Fax
(480) 558-0888
NPI assigned
Jun 30, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Jonathan Lee Staker, DDSNPI 1760573315
Title
Treasurer
Phone
(480) 558-0777

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
Pediatric Dentistry 1223P0221X AZ Primary

Addresses

Primary practice location

2550 E Guadalupe Rd
Suite 101
Gilbert, AZ 85234-5114

Mailing address

2550 E Guadalupe Rd
Suite 101
Gilbert, AZ 85234-5114
Phone (480) 558-0777

National Provider Directory

National Provider Directory

Locations

2550 E Guadalupe Rd
Ste 101
Gilbert, AZ 85234
Phone (480) 272-0070

Practitioners & affiliated clinicians

Practitioners 6

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": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1336146745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 E GUADALUPE RD",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852345114",
            "telephone_number": "480-558-0777",
            "fax_number": "480-558-0888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 E GUADALUPE RD",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852345114",
            "telephone_number": "480-558-0777",
            "fax_number": "480-558-0888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL SPECIALISTS, PPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "STAKER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "480-558-0777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.