NPIMap

Organization Active NPI

Phoenix Oral Surgery Associates PLLC

  • Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1619693793
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PHOENIX ORAL SURGERY ASSOCIATES PLLC
Practice address
20950 N Tatum Blvd Ste 200
Phoenix, AZ 85050-4269
Phone
(480) 284-8087
NPI assigned
Oct 19, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Authorized official

Name
Dr. Vishtasb N/a Broumand, DMD MDNPI 1467485599
Title
Owner
Phone
(480) 284-8087

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
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

20950 N Tatum Blvd Ste 200
Phoenix, AZ 85050-4269

Mailing address

20950 N Tatum Blvd Ste 200
Phoenix, AZ 85050-4269
Phone (480) 284-8087

Other names 1

  • Desert Ridge Oral Surgery Institute Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL computer Direct

National Provider Directory

National Provider Directory

Locations

20950 N Tatum Blvd
Ste 200
Phoenix, AZ 85050
Phone (480) 284-8087

Practitioners & affiliated clinicians

Practitioners 3

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": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1619693793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20950 N TATUM BLVD STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504269",
            "telephone_number": "480-284-8087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20950 N TATUM BLVD STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504269",
            "telephone_number": "480-284-8087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX ORAL SURGERY ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "BROUMAND",
        "authorized_official_first_name": "VISHTASB",
        "authorized_official_middle_name": "N/A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-284-8087",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "computer",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "20950 N Tatum Blvd Ste 200",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850504269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Desert Ridge Oral Surgery Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 19, 2022; 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.