NPIMap

Organization Active NPI

KS Az-1, PC

  • General Practice Dentistry
  • Phoenix, AZ
National Provider Identifier
1588759161
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KS AZ-1, PC
Practice address
3554 W Glendale Ave
Phoenix, AZ 85051-8358
Phone
(602) 233-5665
Fax
(602) 233-5666
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Authorized official

Name
Dr. Dale Mayfield, DMD
Title
President
Phone
(770) 916-5028

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

3554 W Glendale Ave
Phoenix, AZ 85051-8358

Mailing address

1090 Northchase Pkwy SE Ste 150
Marietta, GA 30067-6407
Phone (770) 916-5028

Other names 1

  • KOOL SMILES Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418774400000",
    "number": "1588759161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676407",
            "telephone_number": "770-916-5028",
            "fax_number": "678-247-7858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3554 W GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850518358",
            "telephone_number": "602-233-5665",
            "fax_number": "602-233-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KS AZ-1, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-12-17",
        "status": "A",
        "authorized_official_last_name": "MAYFIELD",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-916-5028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KOOL SMILES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.