NPIMap

Organization Active NPI

LB Dental Inc.

  • Dentist
  • Phoenix, AZ
National Provider Identifier
1407247489
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6073 Issued in AZ
Legal business name
LB DENTAL INC.
Practice address
4045 E Bell Rd
Suite 115
Phoenix, AZ 85032-2236
Phone
(602) 482-5100
Fax
(602) 482-5105
NPI assigned
Feb 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Authorized official

Name
Dr. Luka Bundalo, DDSNPI 1366609125
Title
Owner
Phone
(602) 482-5100

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: 193400000X SINGLE SPECIALTY GROUP 122300000X 6073 AZ Primary

Addresses

Primary practice location

4045 E Bell Rd
Suite 115
Phoenix, AZ 85032-2236

Mailing address

4045 E Bell Rd
Suite 115
Phoenix, AZ 85032-2236
Phone (602) 482-5100

Other identifiers 1

IdentifierTypeStateIssuer
337216OtherAZAHCCCS

National Provider Directory

National Provider Directory

Locations

4045 E Bell Rd
Ste 115
Phoenix, AZ 85032
Phone (602) 482-5100

Practitioners & affiliated clinicians

Practitioners 2

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": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1407247489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 E BELL RD",
            "address_2": "SUITE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322236",
            "telephone_number": "602-482-5100",
            "fax_number": "602-482-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 E BELL RD",
            "address_2": "SUITE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322236",
            "telephone_number": "602-482-5100",
            "fax_number": "602-482-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LB DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "BUNDALO",
        "authorized_official_first_name": "LUKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-482-5100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "6073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "337216",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; 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.