Stan Kidtastic Dental LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

STAN KIDTASTIC DENTAL LLC

Practice address

2510 E Hunt Hwy Ste 29
San Tan Valley, AZ 85143-5208

Phone

(480) 457-4693

NPI assigned

Oct 3, 2019

Last updated

Oct 3, 2019By 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

Faith Gaskins

Title

Director of Credentialing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1558902247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 E HUNT HWY STE 29",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851435208",
            "telephone_number": "480-457-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 E HUNT HWY STE 29",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851435208",
            "telephone_number": "480-457-4693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAN KIDTASTIC DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; 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.