Country Club Dental Flagstaff PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

COUNTRY CLUB DENTAL FLAGSTAFF PLLC

Practice address

5200 E Cortland Blvd Ste C4
Flagstaff, AZ 86004-9341

Phone

(520) 499-9151

NPI assigned

Oct 13, 2026

Last updated

Oct 13, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

H DENTAL GROUP LLCAs reported in NPPES

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

Authorized official

Name

George Salim Hariri, DMD

Title

Manager

Phone

(520) 499-9151

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1791849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791849600000",
    "number": "1508761032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10810 N TATUM BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850286055",
            "telephone_number": "520-499-9151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 E CORTLAND BLVD STE C4",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860049341",
            "telephone_number": "520-499-9151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB DENTAL FLAGSTAFF PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "H DENTAL GROUP LLC",
        "enumeration_date": "2026-10-13",
        "last_updated": "2026-10-13",
        "certification_date": "2026-10-13",
        "status": "A",
        "authorized_official_last_name": "HARIRI",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "SALIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "520-499-9151",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.