NPIMap

Organization Active NPI

Kennedy Dentistry

  • General Practice Dentistry
  • Buckeye, AZ
National Provider Identifier
1447649520
Registry record updated Jan 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5910 Issued in AZ
Legal business name
KENNEDY DENTISTRY
Practice address
4252 N Verrado Way Ste 105
Buckeye, AZ 85396-7596
Phone
(623) 594-8100
Fax
(623) 594-8120
NPI assigned
Jan 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2015

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

Authorized official

Name
Ewa Platacz
Title
Office Manager
Phone
(623) 594-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5910 AZ Primary

Addresses

Primary practice location

4252 N Verrado Way Ste 105
Buckeye, AZ 85396-7596

Mailing address

4252 N Verrado Way Ste 105
Buckeye, AZ 85396-7596
Phone (623) 594-8100

Other names 1

  • MAIN STREET DENTAL Doing business as

National Provider Directory

National Provider Directory

Locations

4252 N Verrado Way
Ste 105
Buckeye, AZ 85396
Phone (602) 214-5479

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": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1447649520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4252 N VERRADO WAY STE 105",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853967596",
            "telephone_number": "623-594-8100",
            "fax_number": "623-594-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4252 N VERRADO WAY STE 105",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853967596",
            "telephone_number": "623-594-8100",
            "fax_number": "623-594-8120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "PLATACZ",
        "authorized_official_first_name": "EWA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "623-594-8100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buckeye, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.