Desert Mountain Endodontics

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

8110 Issued in AZ

Legal business name

DESERT MOUNTAIN ENDODONTICS

Practice address

20542 N Lake Pleasant Rd
#113
Peoria, AZ 85382-9749

Phone

(623) 594-2888

Fax

(623) 328-9474

NPI assigned

Jul 31, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jack Casale, D.D.S.

Title

President

Phone

(623) 594-2888

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1609284801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20542 N LAKE PLEASANT RD",
            "address_2": "#113",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829749",
            "telephone_number": "623-594-2888",
            "fax_number": "623-328-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20542 N LAKE PLEASANT RD",
            "address_2": "#113",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829749",
            "telephone_number": "623-594-2888",
            "fax_number": "623-328-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT MOUNTAIN ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "CASALE",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "623-594-2888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "AZ",
            "license": "8110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Exclusive Provider Organization in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.