NPIMap

Organization Active NPI

Az Life Dentistry, PLLC

  • Dentist
  • Avondale, AZ
National Provider Identifier
1497046395
Registry record updated Apr 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
AZ LIFE DENTISTRY, PLLC
Practice address
13065 W McDowell Rd
Building B, Suite #112
Avondale, AZ 85392-6439
Phone
(623) 455-3600
NPI assigned
Apr 26, 2011
Last updated
Apr 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2011

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

Authorized official

Name
Dr. Shahab Ardalan, DDSNPI 1063493641
Title
Managing Member
Phone
(480) 861-5261

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

13065 W McDowell Rd
Building B, Suite #112
Avondale, AZ 85392-6439

Mailing address

13065 W McDowell Rd
Building B, Suite #112
Avondale, AZ 85392-6439
Phone (623) 455-3600

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1303776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303776000000",
    "number": "1497046395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13065 W MCDOWELL RD",
            "address_2": "BUILDING B, SUITE #112",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926439",
            "telephone_number": "623-455-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13065 W MCDOWELL RD",
            "address_2": "BUILDING B, SUITE #112",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926439",
            "telephone_number": "623-455-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ LIFE DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-26",
        "last_updated": "2011-04-26",
        "status": "A",
        "authorized_official_last_name": "ARDALAN",
        "authorized_official_first_name": "SHAHAB",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "480-861-5261",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avondale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; 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.