Tina Ptacek, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D7818 Issued in AZ

Practice address

15180 N Cotton LN Ste 104
Surprise, AZ 85388-7000

Phone

(623) 214-6543

NPI assigned

Aug 24, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids Dentists of Surprise and Orthodontics, LLP

  • Dentist
  • Surprise, AZ
  • NPI 1508410887
  NPD

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

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591142400000",
    "number": "1649403775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23219 N DEL MONTE DR",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853752372",
            "telephone_number": "623-628-6858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15180 N COTTON LN STE 104",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853887000",
            "telephone_number": "623-214-6543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PTACEK",
        "first_name": "TINA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-24",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "32491",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D7818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professionl Sitter Plus Healthcare LLC
• Melinda Charlene Proffitt, LPN
• Jamila Protho
• Nicole Pruett
• Catherine Przystup, MS
• Alexa Puchta
• Madeline Pullen, SLP-CF
• Farah Punjani
• Rachel Elaine Purcell, MS, ATC
• Tracy Putman

• Pediatric Dentistry in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.