NPIMap

Organization Active NPI

Desert Ridge Implant & Oral Surgery PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Phoenix, AZ
National Provider Identifier
1588960512
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
5196 Issued in AZ
Legal business name
DESERT RIDGE IMPLANT & ORAL SURGERY PC
Practice address
20950 N Tatum Blvd
Ste. 120
Phoenix, AZ 85050-4200
Phone
(480) 563-3960
Fax
(480) 563-3965
NPI assigned
Feb 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Authorized official

Name
Dr. Matthew A. Defelice, DDS
Title
Owner
Phone
(480) 563-3960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 5196 AZ Primary

Addresses

Primary practice location

20950 N Tatum Blvd
Ste. 120
Phoenix, AZ 85050-4200

Mailing address

20950 N Tatum Blvd
Ste. 120
Phoenix, AZ 85050-4200
Phone (480) 563-3960

National Provider Directory

National Provider Directory

Locations

20950 N Tatum Blvd
Ste 120
Phoenix, AZ 85050
Phone (480) 563-3960

NPI Registry JSON

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

{
    "created_epoch": "1297209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1588960512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20950 N TATUM BLVD",
            "address_2": "STE. 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504200",
            "telephone_number": "480-563-3960",
            "fax_number": "480-563-3965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20950 N TATUM BLVD",
            "address_2": "STE. 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504200",
            "telephone_number": "480-563-3960",
            "fax_number": "480-563-3965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT RIDGE IMPLANT & ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-09",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "DEFELICE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-563-3960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "5196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 4, 2011; 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.