NPIMap

Organization Active NPI

Surprise Modern Dentistry LLP

  • General Practice Dentistry
  • Surprise, AZ
National Provider Identifier
1376200261
Registry record updated Nov 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SURPRISE MODERN DENTISTRY LLP
Practice address
13733 N Prasada Pkwy Ste 108
Surprise, AZ 85388-8007
Phone
(623) 777-3329
Fax
(623) 900-2676
NPI assigned
Nov 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2021

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

Authorized official

Name
Joshua J Shaw, DMD
Title
Owner
Phone
(623) 777-3329

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

13733 N Prasada Pkwy Ste 108
Surprise, AZ 85388-8007

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8892

Other names 1

  • Surprise Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

13733 N Prasada Pkwy
Ste 108
Surprise, AZ 85388
Phone (623) 777-3329

Practitioners & affiliated clinicians

Practitioners 4

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": "1637884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637884800000",
    "number": "1376200261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8892",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13733 N PRASADA PKWY STE 108",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853888007",
            "telephone_number": "623-777-3329",
            "fax_number": "623-900-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURPRISE MODERN DENTISTRY LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-26",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-26",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-777-3329",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surprise Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2021; 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.