NPIMap

Organization Active NPI

Phoenix Pediatric Dental

  • Pediatric Dentistry
  • Phoenix, AZ
National Provider Identifier
1437547775
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D5353 Issued in AZ
Legal business name
PHOENIX PEDIATRIC DENTAL
Practice address
6750 N 19TH Ave
Phoenix, AZ 85015-1127
Phone
(602) 242-5741
Fax
(602) 242-5742
NPI assigned
Jan 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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

Authorized official

Name
Luz Pacheco
Title
Human Resource
Phone
(602) 242-5741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X D5353 AZ Primary

Addresses

Primary practice location

6750 N 19TH Ave
Phoenix, AZ 85015-1127

Mailing address

5400 W Northern Ave
Glendale, AZ 85301-1406
Phone (602) 242-5741

National Provider Directory

National Provider Directory
Tax ID family
Compass Point Dental4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5400 W Northern Ave
Glendale, AZ 85301
Phone (623) 500-5793

NPI Registry JSON

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

{
    "created_epoch": "1420675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420675200000",
    "number": "1437547775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 W NORTHERN AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853011406",
            "telephone_number": "602-242-5741",
            "fax_number": "602-242-5742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151127",
            "telephone_number": "602-242-5741",
            "fax_number": "602-242-5742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PEDIATRIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-08",
        "last_updated": "2015-01-08",
        "status": "A",
        "authorized_official_last_name": "PACHECO",
        "authorized_official_first_name": "LUZ",
        "authorized_official_title_or_position": "HUMAN RESOURCE",
        "authorized_official_telephone_number": "602-242-5741"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D5353",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 8, 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.