Avelle Lichfield Ortho LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

AVELLE LICHFIELD ORTHO LLC

Practice address

14140 W Indian School Rd Ste B1
Goodyear, AZ 85395-9293

Phone

(480) 712-9595

NPI assigned

Nov 15, 2024

Organization subpart

No

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

Authorized official

Name

Ethan Larson, DMD, MSNPI 1083975759

Title

Doctor

Phone

(253) 283-2747

Specialties & licenses 1

Addresses

Other names 1

• Avelle Orthodontics Doing business as

Locations

Practitioners 1

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

• Ethan James Larson, D.M.D. M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Gilbert, AZ
  • NPI 1083975759
  NPD Authorized official

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

{
    "created_epoch": "1731628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1770307704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4365 E PECOS RD STE 136",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852958053",
            "telephone_number": "480-712-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14140 W INDIAN SCHOOL RD STE B1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853959293",
            "telephone_number": "480-712-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVELLE LICHFIELD ORTHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "253-283-2747",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avelle Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nshimirimana Asheri
• Donald Lee Askew
• Associated Ophthalmologist
• Melody Attipoe, MSN, APRN, FNP-C
• Av Care Agency LLC
• Sylvia Avila
• Avl Consulting and Evaluation
• Avocare Home Health Plus, Inc
• Samantha Ayala
• Sirrene Seaeda Ayyad, DMD

• Orthodontics and Dentofacial Orthopedics Dentistry in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.