NPIMap

Organization Active NPI

Kino Dental Group

Doing business as dba Frontier Dental

  • General Practice Dentistry
  • Tucson, AZ
National Provider Identifier
1407037807
Registry record updated Apr 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3398 Issued in AZ
Legal business name
KINO DENTAL GROUP
Doing business as
dba Frontier Dental
Practice address
4850 E. Broadway Blvd.
Frontier Dental
Tucson, AZ 85710
Phone
(520) 514-1883
Fax
(520) 514-1997
NPI assigned
Nov 14, 2007
Organization subpart
Yes
Parent organization
KINO DENTAL GROUP DBA FRONTIER DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2011

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

Authorized official

Name
Rodney Jene Gold, D.D.S.NPI 1346256252
Title
President
Phone
(520) 514-1883

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 3398 AZ Primary

Addresses

Primary practice location

4850 E. Broadway Blvd.
Frontier Dental
Tucson, AZ 85710

Mailing address

4850 E. Broadway Blvd
Frontier Dental
Tucson, AZ 85710
Phone (520) 514-1883

Other identifiers 1

IdentifierTypeStateIssuer
092578-006MedicaidAZ

Other names 1

  • dba Frontier Dental Doing business as

National Provider Directory

National Provider Directory
Part of
Kino Dental Group

Locations

4850 E Broadway Blvd
Tucson, AZ 85711
Phone (520) 514-1883

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": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302048000000",
    "number": "1407037807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 E. BROADWAY BLVD",
            "address_2": "FRONTIER DENTAL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85710",
            "telephone_number": "520-514-1883",
            "fax_number": "520-514-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 E. BROADWAY BLVD.",
            "address_2": "FRONTIER DENTAL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85710",
            "telephone_number": "520-514-1883",
            "fax_number": "520-514-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINO DENTAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KINO DENTAL GROUP DBA FRONTIER DENTAL",
        "enumeration_date": "2007-11-14",
        "last_updated": "2011-04-06",
        "status": "A",
        "authorized_official_last_name": "GOLD",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "JENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-514-1883",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "3398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092578-006",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Frontier Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.