NPIMap

Organization Active NPI

Tri-States Dental, Inc.

  • General Practice Dentistry
  • Bullhead City, AZ
National Provider Identifier
1649460221
Registry record updated Jul 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4817 Issued in NV
Legal business name
TRI-STATES DENTAL, INC.
Practice address
1518 Sierra Vista Dr
Bullhead City, AZ 86442-6069
Phone
(928) 704-0144
Fax
(928) 704-9791
NPI assigned
Jul 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2007

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

Authorized official

Name
Dominic DO, D.D.S.
Title
Cfo
Phone
(928) 704-0144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 4817 NV Primary

Addresses

Primary practice location

1518 Sierra Vista Dr
Bullhead City, AZ 86442-6069

Mailing address

1518 Sierra Vista Dr
Bullhead City, AZ 86442-6069
Phone (928) 704-0144

Other identifiers 1

IdentifierTypeStateIssuer
190343MedicaidAZ

National Provider Directory

National Provider Directory

Locations

1518 Sierra Vista Dr
Bullhead City, AZ 86442
Phone (928) 704-0144

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1649460221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1518 SIERRA VISTA DR",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864426069",
            "telephone_number": "928-704-0144",
            "fax_number": "928-704-9791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1518 SIERRA VISTA DR",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864426069",
            "telephone_number": "928-704-0144",
            "fax_number": "928-704-9791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATES DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "DO",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "928-704-0144",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "190343",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bullhead City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; 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.