Individual provider Active NPI

John David Landgren, D.D.S.

  • Pediatric Dentistry
  • Sacaton, AZ
National Provider Identifier
1427260744
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D008855 Issued in AZ
Practice address
483 W. Seed Farm Rd.
Sacaton, AZ 85147-0038
Phone
(602) 528-1200
Fax
(602) 528-1255
NPI assigned
May 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 6546 CO
Pediatric Dentistry 1223P0221X D008855 AZ Primary

Addresses

Primary practice location

483 W. Seed Farm Rd.
Sacaton, AZ 85147-0038

Mailing address

P.O. Box 38
Sacaton, AZ 85147-0038
Phone (602) 528-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20130727000260 TX Practitioner - Oral Surgery 5193966596 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6546COMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gila River Health Care CurrentSince Jun 13, 2013 Accepting new patients
Gila River Health Care Corporation Current Accepting new patients
Gila River Health Care Corporation CurrentSince Jun 13, 2013 Accepting new patients
Gila River Health Care Corporation Current Accepting new patients

Locations

17487 S Healthcare Dr
Laveen, AZ 85339
Phone (520) 550-6000

17487 S Healthcare Dr
#H
Laveen, AZ 85339
Phone (520) 550-6000

Organizations & group practices 4

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": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451520000000",
    "number": "1427260744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 38",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851470038",
            "telephone_number": "602-528-1200",
            "fax_number": "602-528-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 W. SEED FARM RD.",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851470038",
            "telephone_number": "602-528-1200",
            "fax_number": "602-528-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDGREN",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2015-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "6546",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D008855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacaton, AZ

Sources for this page

Verify at the official NPI Registry.