Mesa Dental Group LLC

Primary specialty

DentistTaxonomy code 122300000X

License

D5677 Issued in AZ

Legal business name

MESA DENTAL GROUP LLC

Doing business as

Gilbert Road Dental Care

Practice address

2017 E Adobe St
Suite 6
Mesa, AZ 85213-6740

Phone

(480) 649-7200

Fax

(480) 649-7219

NPI assigned

Sep 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bartel Vanoostendorp V, DDS

Title

Dentist

Phone

(480) 649-7200

Specialties & licenses 1

Addresses

Other names 1

• Gilbert Road Dental Care Doing business as

Locations

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659462372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 E ADOBE ST",
            "address_2": "SUITE 6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852136740",
            "telephone_number": "480-649-7200",
            "fax_number": "480-649-7219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 E ADOBE ST",
            "address_2": "SUITE 6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852136740",
            "telephone_number": "480-649-7200",
            "fax_number": "480-649-7219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VANOOSTENDORP",
        "authorized_official_first_name": "BARTEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "480-649-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "V",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D5677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gilbert Road Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mesa Dental Arizona LLC
• Mesa Dental Care
• Mesa Dental Health
• Mesa Dental Partners LLC (Risas Dental and Braces)
• Mesa Dental PLLC
• Mesa Detox LLC
• Mesa Development Sub, LLC (Agave Ridge Behavioral Hospital)

• Dentist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.