NPIMap

Organization Active NPI

Mesa Dental Arizona LLC

  • Dentist
  • Phoenix, AZ
National Provider Identifier
1447780135
Registry record updated Jun 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9690 Issued in AZ
Legal business name
MESA DENTAL ARIZONA LLC
Practice address
3320 W Southern Ave #111
Phoenix, AZ 85041
Phone
(602) 305-8800
NPI assigned
Jun 14, 2017
Last updated
Jun 14, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
MESA DENTAL ARIZONA LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2017

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

Authorized official

Name
Mr. Mark Wilkes Morris, DMD
Title
Sole Owner/General Dentist
Phone
(312) 339-0588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9690 AZ Primary

Addresses

Primary practice location

3320 W Southern Ave #111
Phoenix, AZ 85041

Mailing address

1 East Washington St Ste 500
Phoenix, AZ 85004
Phone (480) 696-1095

Other names 1

  • Southern Dental Other name

National Provider Directory

National Provider Directory
Tax ID family
Mesa Dental Arizona LLC2 organizations share this tax ID, including this one
Part of
Mesa Dental Arizona LLC

Other organizations with this tax ID 1

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

Locations

1 E Washington St
Ste 500
Phoenix, AZ 85004
Phone (602) 269-6011

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497398400000",
    "number": "1447780135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EAST WASHINGTON ST STE 500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85004",
            "telephone_number": "480-696-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 W SOUTHERN AVE #111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85041",
            "telephone_number": "602-305-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA DENTAL ARIZONA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MESA DENTAL ARIZONA LLC",
        "enumeration_date": "2017-06-14",
        "last_updated": "2017-06-14",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WILKES",
        "authorized_official_title_or_position": "SOLE OWNER/GENERAL DENTIST",
        "authorized_official_telephone_number": "312-339-0588",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "9690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 14, 2017; 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.