Intra Dental, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7163 Issued in AZ

Legal business name

INTRA DENTAL, INC.

Doing business as

Cornerstone Dental Care

Practice address

6135 N 35TH Ave
Suite 135
Phoenix, AZ 85017-1950

Phone

(602) 973-0325

Fax

(602) 973-9704

NPI assigned

May 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Roy D Shim, DDS

Title

President

Phone

(310) 227-0944

Specialties & licenses 1

Addresses

Other names 1

• Cornerstone Dental Care Doing business as

Locations

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

{
    "created_epoch": "1179014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186358400000",
    "number": "1609081652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6135 N 35TH AVE",
            "address_2": "SUITE 135",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850171950",
            "telephone_number": "602-973-0325",
            "fax_number": "602-973-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6135 N 35TH AVE",
            "address_2": "SUITE 135",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850171950",
            "telephone_number": "602-973-0325",
            "fax_number": "602-973-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTRA DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-13",
        "last_updated": "2007-08-06",
        "status": "A",
        "authorized_official_last_name": "SHIM",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-227-0944",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D7163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; 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.