NPIMap

Organization Active NPI

Prescott Modern Dentistry, LLP

Doing business as Prescott Modern Dentistry

  • General Practice Dentistry
  • Irvine, CA
National Provider Identifier
1346530417
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PRESCOTT MODERN DENTISTRY, LLP
Doing business as
Prescott Modern Dentistry
Practice address
2860 Michelle FL 2
Irvine, CA 92606-1008
Phone
(714) 368-2077
Fax
(714) 368-2092
NPI assigned
Apr 11, 2011
Last updated
Apr 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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

Authorized official

Name
Dr. Carl C Fairchild, DDS
Title
Owner Doctor
Phone
(928) 777-8550

Specialties & licenses 1

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

Addresses

Primary practice location

2860 Michelle FL 2
Irvine, CA 92606-1008

Mailing address

1200 Gail Gardner Way
Prescott, AZ 86305-3499
Phone (928) 777-8550

Other names 1

  • Prescott Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1200 Gail Gardner Way
Prescott, AZ 86305
Phone (282) 274-3059

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": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1346530417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 GAIL GARDNER WAY",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863053499",
            "telephone_number": "928-777-8550",
            "fax_number": "928-443-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE FL 2",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061008",
            "telephone_number": "714-368-2077",
            "fax_number": "714-368-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT MODERN DENTISTRY, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-11",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "FAIRCHILD",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "928-777-8550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prescott Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.