Active NPI
Dirk Michael Donovan, DMD, MSD
- Periodontics
- Tempe, AZ
National Provider Identifier
1548472798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 7911
- Practice address
- 6601 S Rural Rd
Tempe, AZ 85283 - Phone
- (480) 756-6522
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 7911 | AZ | Primary |
Addresses
Primary practice location
6601 S Rural Rd
Tempe, AZ 85283
Mailing address
20100 N 78TH Place #1196
Scottsdale, AZ 85255
Phone (630) 991-7056
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2017 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7911 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548472798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20100 N 78TH PLACE #1196",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "85255",
"telephone_number": "630-991-7056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6601 S RURAL RD",
"city": "TEMPE",
"state": "AZ",
"postal_code": "85283",
"telephone_number": "480-756-6522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOVAN",
"first_name": "DIRK",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DMD, MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, Periodontics",
"state": "AZ",
"license": "7911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.