Keith George Serrano, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D012285 Issued in AZ

Practice address

2755 S 99TH Ave Ste 105
Tolleson, AZ 85353-1404

Phone

(623) 478-1624

NPI assigned

Jul 24, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Promenade Dental Group, LLP

  • General Practice Dentistry
  • Tolleson, AZ
  • NPI 1285798462
  NPD (past)

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

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1760210306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8503 N 110TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853453477",
            "telephone_number": "602-400-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 S 99TH AVE STE 105",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853531404",
            "telephone_number": "623-478-1624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRANO",
        "first_name": "KEITH",
        "middle_name": "GEORGE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D012285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mavis Scott
• Jeremy Thomas Scotten, LMT
• Seeds of Love 1 LLC
• Rachel M. Segovia
• Serene Surroundings Behavioral Home LLC
• Robin Kay Sharples-Ray, LM, CPM
• Shiva Shirvanifar
• Judy L Shively, LPN
• Aline Sibomana, LMSW
• Skyler Blue Family Chiropractic LLC

• General Practice Dentistry in Tolleson, AZ
• Providers in Tolleson, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.