East Valley Implant and Periodontal PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

EAST VALLEY IMPLANT AND PERIODONTAL PLLC

Practice address

3048 E Baseline Rd Ste 112
Mesa, AZ 85204-7287

Phone

(480) 376-2848

NPI assigned

Sep 10, 2019

Organization subpart

No

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

Authorized official

Name

Victoria Johnson

Title

Cro

Phone

(941) 444-0558

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1457900656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8952 E DESERT COVE AVE # D101",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606775",
            "telephone_number": "480-376-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047287",
            "telephone_number": "480-376-2848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8952 E Desert Cove Ave # D101",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852606775",
            "country_code": "US",
            "telephone_number": "480-376-2848 x2",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST VALLEY IMPLANT AND PERIODONTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "941-444-0558"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Valley Footcare PLLC
• East Valley Glaucoma Inc
• East Valley Hearing Center Inc
• East Valley Hospice P.L.C.
• East Valley Implant & Periodontal Center
• East Valley Infectious Disease Medicine LLC
• East Valley Integrated Hospitalist PLLC
• East Valley Kidney Center, Inc.
• East Valley Kidney Specialist PLLC Health Care
• East Valley Medical Group, Inc.

• Periodontics in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; 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.