NPIMap

Organization Active NPI

On Site Dental, PC

  • Pediatric Dentistry
  • Camp Verde, AZ
National Provider Identifier
1487794798
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ON SITE DENTAL, PC
Practice address
1996 Dougs Park Rd
Camp Verde, AZ 86322
Phone
(928) 567-1832
Fax
(928) 567-6500
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James J. Hisrich, DDS
Title
President
Phone
(928) 567-1832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X AZ Primary

Addresses

Primary practice location

1996 Dougs Park Rd
Camp Verde, AZ 86322

Mailing address

PO Box 767
Camp Verde, AZ 86322-0767
Phone (928) 567-1832

Other identifiers 2

IdentifierTypeStateIssuer
G2381MedicaidNM
723157MedicaidAZ

Other names 1

  • On Site Dental, New Mexico Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487794798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "CAMP VERDE",
            "state": "AZ",
            "postal_code": "863220767",
            "telephone_number": "928-567-1832",
            "fax_number": "928-567-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1996 DOUGS PARK RD",
            "city": "CAMP VERDE",
            "state": "AZ",
            "postal_code": "86322",
            "telephone_number": "928-567-1832",
            "fax_number": "928-567-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ON SITE DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HISRICH",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-567-1832",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G2381",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "723157",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "On Site Dental, New Mexico",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Camp Verde, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.