NPIMap

Organization Active NPI

Fairway Dental Az PLLC

  • Dental Clinic/Center
  • Litchfield Park, AZ
National Provider Identifier
1609730779
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
FAIRWAY DENTAL AZ PLLC
Practice address
250 Village Parkway
Suite 203/204
Litchfield Park, AZ 85340
Phone
(623) 428-1808
Fax
(623) 428-0690
NPI assigned
Dec 12, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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

Authorized official

Name
Dr. Justin Ewell, D.M.D.NPI 1033568688
Title
Owner/Denist
Phone
(623) 428-1808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

250 Village Parkway
Suite 203/204
Litchfield Park, AZ 85340

Mailing address

250 Village Parkway
Suite 205
Litchfield Park, AZ 85340
Phone (623) 428-1808

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": "1765497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766361600000",
    "number": "1609730779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 VILLAGE PARKWAY",
            "address_2": "SUITE 205",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "85340",
            "telephone_number": "623-428-1808",
            "fax_number": "623-428-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 VILLAGE PARKWAY",
            "address_2": "SUITE 203/204",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "85340",
            "telephone_number": "623-428-1808",
            "fax_number": "623-428-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY DENTAL AZ PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-12",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A",
        "authorized_official_last_name": "EWELL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER/DENIST",
        "authorized_official_telephone_number": "623-428-1808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Litchfield Park, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2025; 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.