Thomas Scott Durisek, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4777 Issued in AZ

Practice address

6520 N 7TH Ave
Suite #1
Phoenix, AZ 85013-1158

Phone

(602) 246-9013

Fax

(602) 249-7460

NPI assigned

Mar 13, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Geishun Management, Inc

  dba Open Wide Dental

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1528333168
  NPD (past) Authorized official
• Thomas S Durisek, DDS, PC

  dba Open Wide Dental

  • Dental Clinic/Center
  • Phoenix, AZ
  • NPI 1295919751
  NPD (past) Authorized official

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467585257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 N 7TH AVE",
            "address_2": "SUITE #1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131158",
            "telephone_number": "602-246-9013",
            "fax_number": "602-249-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 N 7TH AVE",
            "address_2": "SUITE #1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850131158",
            "telephone_number": "602-246-9013",
            "fax_number": "602-249-7460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURISEK",
        "first_name": "THOMAS",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "4777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chardae Simone Durden, OTR/L
• Teresa Durfee, REGISTERED NURSE
• Donald Ralph Durham, PH.D.
• Joseph R Durio, P.A.-C.
• Michael Ray Durio, RN
• Karsen Durkiewicz
• Katelyn Durkin
• Shane Durkin, MD
• Ja'Von J Durley, MD
• Kerry Rose Durnan, FNP-BC

• 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 Jul 8, 2007; 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.