NPIMap

Organization Active NPI

East Valley Dental Anesthesia, PLLC

  • Dental Anesthesiology
  • Gilbert, AZ
National Provider Identifier
1518366111
Registry record updated Aug 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AnesthesiologyTaxonomy code 1223D0004X
License
5604 Issued in AZ
Legal business name
EAST VALLEY DENTAL ANESTHESIA, PLLC
Practice address
67 S Higley Rd
Suite 103
Gilbert, AZ 85296-1166
Phone
(480) 518-5502
Fax
(480) 219-9234
NPI assigned
Aug 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2014

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

Authorized official

Name
Dr. Marvin Todd Christensen, DMD
Title
Owner/Operator
Phone
(480) 518-5502

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental AnesthesiologyGroup: 193400000X SINGLE SPECIALTY GROUP 1223D0004X 5604 AZ Primary

Addresses

Primary practice location

67 S Higley Rd
Suite 103
Gilbert, AZ 85296-1166

Mailing address

67 S Higley Rd
Suite 103
Gilbert, AZ 85296-1166
Phone (480) 518-5502

National Provider Directory

National Provider Directory

Locations

67 S Higley Rd
Ste 103
Gilbert, AZ 85296
Phone (480) 518-5502

NPI Registry JSON

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408406400000",
    "number": "1518366111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 S HIGLEY RD",
            "address_2": "SUITE 103",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852961166",
            "telephone_number": "480-518-5502",
            "fax_number": "480-219-9234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 S HIGLEY RD",
            "address_2": "SUITE 103",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852961166",
            "telephone_number": "480-518-5502",
            "fax_number": "480-219-9234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY DENTAL ANESTHESIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-19",
        "last_updated": "2014-08-19",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "480-518-5502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "AZ",
            "license": "5604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2014; 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.