Active NPI
Collin McClellan
- Dentist
- Goodyear, AZ
National Provider Identifier
1487581112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D012836
- Practice address
- 15260 W McDowell Rd
Goodyear, AZ 85395-2530 - Phone
- (623) 207-7838
- NPI assigned
- May 6, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D012836 | AZ | Primary |
Addresses
Primary practice location
15260 W McDowell Rd
Goodyear, AZ 85395-2530
Mailing address
17722 N 79TH Ave Apt 2125
Glendale, AZ 85308-8680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D012836 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Goodyear Modern Dentistry, LLP | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781568000000",
"number": "1487581112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17722 N 79TH AVE APT 2125",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15260 W MCDOWELL RD",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853952530",
"telephone_number": "623-207-7838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "COLLIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-05-06",
"last_updated": "2026-06-16",
"certification_date": "2026-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D012836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.