NPIMap

Organization Active NPI

East Valley Implant & Periodontal Center

  • Periodontics
  • Mesa, AZ
National Provider Identifier
1376019075
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
EAST VALLEY IMPLANT & PERIODONTAL CENTER
Practice address
3048 E Baseline Rd Ste 112
Mesa, AZ 85204-7287
Phone
(480) 558-4504
Fax
(480) 827-9703
NPI assigned
Oct 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Authorized official

Name
Mrs. Brett E Lee
Title
Office Manager
Phone
(480) 558-4504

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

3048 E Baseline Rd Ste 112
Mesa, AZ 85204-7287

Mailing address

3048 E Baseline Rd Ste 112
Mesa, AZ 85204-7287
Phone (480) 558-4504

National Provider Directory

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.

NPI Registry JSON

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

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539907200000",
    "number": "1376019075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047287",
            "telephone_number": "480-558-4504",
            "fax_number": "480-827-9703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047287",
            "telephone_number": "480-558-4504",
            "fax_number": "480-827-9703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY IMPLANT & PERIODONTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-19",
        "last_updated": "2018-10-19",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "480-558-4504",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; 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.