Individual provider Active NPI

Aman Kaur

  • Dentist
  • Phoenix, AZ
National Provider Identifier
1396398806
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D010434 Issued in AZ
Practice address
3320 W Southern Ave Ste 111
Phoenix, AZ 85041-4307
Phone
(602) 305-8800
NPI assigned
Jul 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D010434 AZ Primary

Addresses

Primary practice location

3320 W Southern Ave Ste 111
Phoenix, AZ 85041-4307

Mailing address

3320 W Southern Ave Ste 111
Phoenix, AZ 85041-4307

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://southerndentalaz.com/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250916002589 AZ Order and Referring Only - DentistPractitioner - Dentist 0244734077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D010434AZMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Dental LLC Dentist PastSince Jul 28, 2019 Accepting new patients
Mesa Dental Arizona LLC Dentist PastSince Jul 28, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1396398806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 W SOUTHERN AVE STE 111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850414307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 W SOUTHERN AVE STE 111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850414307",
            "telephone_number": "602-305-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUR",
        "first_name": "AMAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D010434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://southerndentalaz.com/",
            "affiliation": "N",
            "address_1": "3320 W Southern Ave Ste 111",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850414307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.