Core Family Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CORE FAMILY DENTAL

Practice address

13460 N 94TH Dr Ste K4
Peoria, AZ 85381-4249

Phone

(232) 231-0366

NPI assigned

Jul 23, 2020

Last updated

Jul 28, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marvin Blane Jackson, DDSNPI 1265624332

Title

Owner

Phone

(435) 637-2100

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marvin Blane Jackson, DDS

  • Dentist
  • Tempe, AZ
  • NPI 1265624332
  Authorized official Same address or phone

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1689283814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13460 N 94TH DR STE K4",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814249",
            "telephone_number": "232-231-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13460 N 94TH DR STE K4",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814249",
            "telephone_number": "232-231-0366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-23",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "BLANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-637-2100",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "586868",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@your-domain.com",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "13460 N 94th Dr Ste K4",
            "city": "Peoria",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853814249",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cooperman Family Dentistry PLLC (Benjamin Cooperman DMD)
• Blair W. Copp, DC
• Copper Sky Dental, PLLC
• Gregory J Cordes, PA
• Ellen Diane Cordova, PA-C
• Core Family Dental, LLC
• Debra Sharene Corley, DNP, RN, AGNP-C
• Marisa Christina Cornejo, MD
• Cornerstone Chiropractic Clinic, LLC
• Cornerstone Mobile Imaging

• Dental Clinic/Center in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.