Four Peaks Family Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

6575 Issued in AZ

Legal business name

FOUR PEAKS FAMILY DENTISTRY

Practice address

3666 N Miller Rd
109
Scottsdale, AZ 85251-4599

Phone

(480) 994-9485

Fax

(480) 481-3800

NPI assigned

Aug 13, 2007

Last updated

Aug 13, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Clark III, DDSNPI 1780786632

Title

Doctor

Phone

(480) 994-9485

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Wallace Clark III, DDS

  • Dentist
  • Scottsdale, AZ
  • NPI 1780786632
  NPD (past) Authorized official
• Jennifer Marie Clark, DDS

  • Dentist
  • Scottsdale, AZ
  • NPI 1225130990
  NPD (past)

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186963200000",
    "number": "1528250693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3666 N MILLER RD",
            "address_2": "109",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852514599",
            "telephone_number": "480-994-9485",
            "fax_number": "480-481-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3666 N MILLER RD",
            "address_2": "109",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852514599",
            "telephone_number": "480-994-9485",
            "fax_number": "480-481-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR PEAKS FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2007-08-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "480-994-9485",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "5498",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "6575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "955940",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "619934",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Lynn Fought, M.S., CCC-SLP, OTD
• Foundations Developmental House
• Fountain Hills Recovery, LLC
• Sophia J Fountis, D.O.
• Four Peaks Counseling Services, PLC
• Four Peaks Neurology, P.C.
• Brian David Fow, D.D.S.
• Michael David Fow, D.D.S.
• Christopher William Fowler, D.D.S.
• Kristina M Fowler, COTA/L

• Dental Clinic/Center in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; 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.