NPIMap

Organization Active NPI

Mountainside Dental Group, LLC

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1518270248
Registry record updated Jul 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
L16075880 Issued in AZ
Legal business name
MOUNTAINSIDE DENTAL GROUP, LLC
Practice address
6549 E University Dr
Suite B
Mesa, AZ 85205-7600
Phone
(480) 981-0590
NPI assigned
Jul 22, 2010
Last updated
Jul 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2010

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

Authorized official

Name
Daron Clare
Title
General Manager
Phone
(480) 981-0590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X L16075880 AZ Primary

Addresses

Primary practice location

6549 E University Dr
Suite B
Mesa, AZ 85205-7600

Mailing address

6549 E University Dr
Suite B
Mesa, AZ 85205-7600
Phone (480) 981-0590

National Provider Directory

National Provider Directory

Locations

6549 E University Dr
Ste B
Mesa, AZ 85205
Phone (480) 981-0590

NPI Registry JSON

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

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279756800000",
    "number": "1518270248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6549 E UNIVERSITY DR",
            "address_2": "SUITE B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852057600",
            "telephone_number": "480-981-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6549 E UNIVERSITY DR",
            "address_2": "SUITE B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852057600",
            "telephone_number": "480-981-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSIDE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-22",
        "last_updated": "2010-07-22",
        "status": "A",
        "authorized_official_last_name": "CLARE",
        "authorized_official_first_name": "DARON",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "480-981-0590"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "L16075880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; 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.