Queen Creek Implants & Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

QUEEN CREEK IMPLANTS & PERIODONTICS

Practice address

22363 E Domingo Rd Ste 103
Queen Creek, AZ 85142-0353

Phone

(480) 247-6558

Fax

(480) 275-2404

NPI assigned

Jun 24, 2024

Last updated

Jul 15, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Benavidez

Title

Office Manager

Phone

(480) 247-6558

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1639913692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22363 E DOMINGO RD STE 103",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851420353",
            "telephone_number": "480-247-6558",
            "fax_number": "480-275-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22363 E DOMINGO RD STE 103",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851420353",
            "telephone_number": "480-247-6558",
            "fax_number": "480-275-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN CREEK IMPLANTS & PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "BENAVIDEZ",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "480-247-6558"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• QC District Medical Group LLC
• QC Medical Group LLC
• QC Valley Medical Centers, LLC
• Queen Creek Back Care, LLC
• Queen Creek Counseling LLC
• Queen Creek Medical, PLLC (Queen Creek Medical)
• Queen Creek Modern Dentistry, LLP
• Queen Creek Naturopathic PLLC
• Queen Creek Primary Care, P.C.
• Queen Creek Smiles, LLP (Queen Creek Smiles)

• Periodontics in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.