NPIMap

Organization Active NPI

Laveen Modern Dentistry, LLP

Doing business as Laveen Modern Dentistry

  • General Practice Dentistry
  • Laveen, AZ
National Provider Identifier
1497064851
Registry record updated Dec 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAVEEN MODERN DENTISTRY, LLP
Doing business as
Laveen Modern Dentistry
Practice address
5045 W Baseline Rd Ste 135
Laveen, AZ 85339-7394
Phone
(602) 237-0613
Fax
(602) 237-0365
NPI assigned
Oct 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2013

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

Authorized official

Name
Dr. Brian Nelson, DMD
Title
Owner DMD
Phone
(602) 237-0613

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

5045 W Baseline Rd Ste 135
Laveen, AZ 85339-7394

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Laveen Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1286150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388448000000",
    "number": "1497064851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5045 W BASELINE RD STE 135",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853397394",
            "telephone_number": "602-237-0613",
            "fax_number": "602-237-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVEEN MODERN DENTISTRY, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-04",
        "last_updated": "2013-12-31",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER DMD",
        "authorized_official_telephone_number": "602-237-0613",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laveen Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laveen, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2013; 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.