NPIMap

Organization Active NPI

Val Vista Dental Group, LLC

  • Dentist
  • Gilbert, AZ
National Provider Identifier
1386851889
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D4900 Issued in AZ
Legal business name
VAL VISTA DENTAL GROUP, LLC
Practice address
1395 E Warner Rd Ste 105C
Gilbert, AZ 85296-3160
Phone
(480) 558-0212
Fax
(480) 558-0216
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Amir Michael Etebari, D.D.SNPI 1992724173
Title
Managing Member
Phone
(480) 558-0212

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
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D4900 AZ Primary

Addresses

Primary practice location

1395 E Warner Rd Ste 105C
Gilbert, AZ 85296-3160

Mailing address

1395 E Warner Rd # 105C
Gilbert, AZ 85296-3160
Phone (480) 558-0212

National Provider Directory

National Provider Directory

Locations

1395 E Warner Rd
Ste 105C
Gilbert, AZ 85296
Phone (480) 558-0212

Practitioners & affiliated clinicians

Practitioners 3

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": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386851889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 E WARNER RD # 105C",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852963160",
            "telephone_number": "480-558-0212",
            "fax_number": "480-558-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 E WARNER RD STE 105C",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852963160",
            "telephone_number": "480-558-0212",
            "fax_number": "480-558-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAL VISTA DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ETEBARI",
        "authorized_official_first_name": "AMIR",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "480-558-0212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D4900",
            "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 Aug 22, 2020; 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.