Alta Sky Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ALTA SKY DENTAL, LLC

Practice address

4303 W Peoria Ave
Suite 104
Glendale, AZ 85302-2005

Phone

(623) 374-3714

NPI assigned

Sep 4, 2014

Last updated

Sep 4, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jared Justice

Title

Member

Phone

(858) 208-8451

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1396146759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4303 W PEORIA AVE",
            "address_2": "SUITE 104",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853022005",
            "telephone_number": "623-374-3714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 W PEORIA AVE",
            "address_2": "SUITE 104",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853022005",
            "telephone_number": "623-374-3714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA SKY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "858-208-8451"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.