NPIMap

Organization Active NPI

Prescott Endodontic Associates PC

  • Endodontics
  • Prescott, AZ
National Provider Identifier
1588620231
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
D5788 Issued in AZ
Legal business name
PRESCOTT ENDODONTIC ASSOCIATES PC
Practice address
1658 Oaklawn Drive
Ste B
Prescott, AZ 86305
Phone
(928) 771-1640
Fax
(928) 771-1673
NPI assigned
Apr 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Christopher D Smith, DDSNPI 1104945682
Title
President
Phone
(928) 771-1640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X D5788 AZ Primary

Addresses

Primary practice location

1658 Oaklawn Drive
Ste B
Prescott, AZ 86305

Mailing address

1658 Oaklawn Drive
Ste B
Prescott, AZ 86305
Phone (928) 771-1640

Other identifiers 1

IdentifierTypeStateIssuer
1516207OtherUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

1658 Oaklawn Dr
Ste B
Prescott, AZ 86305
Phone (928) 771-1640

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1588620231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1658 OAKLAWN DRIVE",
            "address_2": "STE B",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86305",
            "telephone_number": "928-771-1640",
            "fax_number": "928-771-1673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1658 OAKLAWN DRIVE",
            "address_2": "STE B",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86305",
            "telephone_number": "928-771-1640",
            "fax_number": "928-771-1673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT ENDODONTIC ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-771-1640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "AZ",
            "license": "D5788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1516207",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.