Active NPI
Bryan Joseph Deavila, D.D.S.
- General Practice Dentistry
- Phoenix, AZ
National Provider Identifier
1609079482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6060
- Practice address
- 1422 W Camelback Rd
Phoenix, AZ 85013-2177 - Phone
- (602) 336-1111
- Fax
- (844) 313-7604
- NPI assigned
- Jun 7, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6060 | AZ | Primary |
Addresses
Primary practice location
1422 W Camelback Rd
Phoenix, AZ 85013-2177
Mailing address
1422 W Camelback Rd
Phoenix, AZ 85013-2177
Phone (602) 336-1111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6060 | AZ | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Da Vinci Dental Phoenix | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Phoenix, AZ
- NPI 1477833069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1609079482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1422 W CAMELBACK RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850132177",
"telephone_number": "602-336-1111",
"fax_number": "844-313-7604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1422 W CAMELBACK RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850132177",
"telephone_number": "602-336-1111",
"fax_number": "844-313-7604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAVILA",
"first_name": "BRYAN",
"middle_name": "JOSEPH",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-07",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "6060",
"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 Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.