Valley Dental L.L.C.

Primary specialty

DentistTaxonomy code 122300000X

License

D6107 Issued in AZ

Legal business name

VALLEY DENTAL L.L.C.

Practice address

953 E Elliot Rd
Suite 102
Tempe, AZ 85284-1561

Phone

(480) 839-7996

Fax

(480) 752-3231

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Marisa Medlock

Title

Office Manager

Phone

(480) 839-7996

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508072851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "953 E ELLIOT RD",
            "address_2": "SUITE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852841561",
            "telephone_number": "480-839-7996",
            "fax_number": "480-752-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "953 E ELLIOT RD",
            "address_2": "SUITE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852841561",
            "telephone_number": "480-839-7996",
            "fax_number": "480-752-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY DENTAL L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MEDLOCK",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "480-839-7996",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D6107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Dentist in Arizona

• 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.