NPIMap

Organization Active NPI

Phoenix Dental Center PLLC

  • Dentist
  • Phoenix, AZ
National Provider Identifier
1679974232
Registry record updated Sep 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8657 Issued in AZ
Legal business name
PHOENIX DENTAL CENTER PLLC
Practice address
1950 W Indian School Rd Ste 6
Phoenix, AZ 85015-5114
Phone
(602) 650-1700
Fax
(602) 650-1704
NPI assigned
Sep 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2014

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

Authorized official

Name
Jason H NordeanNPI 1184725426
Title
Dentist
Phone
(602) 650-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 8657 AZ Primary

Addresses

Primary practice location

1950 W Indian School Rd Ste 6
Phoenix, AZ 85015-5114

Mailing address

1950 W Indian School Rd Ste 6
Phoenix, AZ 85015-5114
Phone (602) 650-1700

Other identifiers 1

IdentifierTypeStateIssuer
816919MedicaidAZ

Other names 1

  • Phoenix Dental center pllc Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1410480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1679974232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 W INDIAN SCHOOL RD STE 6",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155114",
            "telephone_number": "602-650-1700",
            "fax_number": "602-650-1704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 W INDIAN SCHOOL RD STE 6",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155114",
            "telephone_number": "602-650-1700",
            "fax_number": "602-650-1704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX DENTAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-12",
        "last_updated": "2014-09-12",
        "status": "A",
        "authorized_official_last_name": "NORDEAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "602-650-1700"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "8657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "816919",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Dental center pllc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; 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.