Plaza Family Dental Inc

Key facts

NPI

1669958781

Entity type

Organization (NPI type 2)

Primary specialty

Dentist 122300000X

License

D009244 (AZ)

Legal business name

PLAZA FAMILY DENTAL INC

Practice address

9145 W Thunderbird Rd Ste H105
Peoria, AZ 85381-4820

Phone

(623) 979-7477

NPI assigned

Jul 11, 2018

Organization subpart

No

Authorized official

Name

Tim J Wildung

Title

Ceo

Phone

(602) 391-4107

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 11, 2018.

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1669958781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 E SOUTHERN AVE STE A-122",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092790",
            "telephone_number": "602-391-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9145 W THUNDERBIRD RD STE H105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814820",
            "telephone_number": "623-979-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLAZA FAMILY DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-11",
        "last_updated": "2018-07-11",
        "status": "A",
        "authorized_official_last_name": "WILDUNG",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-391-4107"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D009244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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