Main Street Practice LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MAIN STREET PRACTICE LLC

Doing business as

Canyon Dental

Practice address

2837 W Northern Ave
Phoenix, AZ 85051-6646

Phone

(602) 995-2419

NPI assigned

Jun 18, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Julie McLeod

Title

Ceo

Phone

(520) 290-6181

Specialties & licenses 1

Addresses

Other names 1

• Canyon Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Josahua Tran, DDS

  • Dentist
  • Phoenix, AZ
  • NPI 1265626154
  NPD (past)

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447455670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11550 E IRVINGTON RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857478925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2837 W NORTHERN AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850516646",
            "telephone_number": "602-995-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCLEOD",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-290-6181"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Maichl, PMHNP
• Anne Lauren Maiden- Hope, D.O.
• James Ndungu Maigua, PMHNP-BC
• Janette Mailo, MD
• John Mailolo
• Jacquelyn Mainelli, RD
• Charles Maingot, LCSW
• Bethany E Mainville-Brooks, CNM
• Bobbi Maisenbacher, RN
• Yousef Monzer Maita, DO

• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.