South Frontage Road Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTH FRONTAGE ROAD DENTAL PLLC

Doing business as

Gila Ridge Dental -Foothills

Practice address

11259 S Frontage Rd Ste 103
Yuma, AZ 85367-7883

Phone

(928) 342-7351

NPI assigned

Mar 9, 2022

Organization subpart

No

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

Authorized official

Name

Vicenta Reyes

Title

Credentialing Lead

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Gila Ridge Dental -Foothills Doing business as

Locations

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

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1497402465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11259 S FRONTAGE RD STE 103",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853677883",
            "telephone_number": "928-342-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11259 S FRONTAGE RD STE 103",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853677883",
            "telephone_number": "928-342-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH FRONTAGE ROAD DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "VICENTA",
        "authorized_official_title_or_position": "CREDENTIALING LEAD",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gila Ridge Dental -Foothills",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Yuma, AZ
• Providers in Yuma, 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 Mar 9, 2022; 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.