NPIMap

Organization Active NPI

Pda Holdings West, LLC

  • Dental Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1760188098
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PDA HOLDINGS WEST, LLC
Practice address
5109 W Thomas Rd Ste 300
Phoenix, AZ 85031-3944
Phone
(602) 472-3553
Fax
(602) 687-9844
NPI assigned
Feb 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Jeramy Tarwater
Title
President
Phone
(602) 253-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

5109 W Thomas Rd Ste 300
Phoenix, AZ 85031-3944

Mailing address

5109 W Thomas Rd Ste 300
Phoenix, AZ 85031-3944
Phone (602) 472-3553

Other names 1

  • Magic Smiles Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

5109 W Thomas Rd
Phoenix, AZ 85031

Practitioners & affiliated clinicians

Practitioners 7

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": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1760188098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5109 W THOMAS RD STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850313944",
            "telephone_number": "602-472-3553",
            "fax_number": "602-687-9844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5109 W THOMAS RD STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850313944",
            "telephone_number": "602-472-3553",
            "fax_number": "602-687-9844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDA HOLDINGS WEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "TARWATER",
        "authorized_official_first_name": "JERAMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-253-6600"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magic Smiles Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 7, 2023; 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.