Walter Plunkett, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D012262 Issued in AZ

Practice address

1712 S Country Club Dr Ste 104
Mesa, AZ 85210-6046

Phone

(480) 376-0593

NPI assigned

Jul 8, 2024

Last updated

Jul 28, 2024By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mesa Valley Modern Dentistry, LLP

  dba Mesa Valley Modern Dentistry

  • Dentist
  • Mesa, AZ
  • NPI 1487190880
  NPD (past)

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722124800000",
    "number": "1770329872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 W CULLUMBER AVE APT 1030",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852334907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 S COUNTRY CLUB DR STE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106046",
            "telephone_number": "480-376-0593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4401 E McKellips Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852152558",
            "country_code": "US",
            "telephone_number": "480-550-8204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PLUNKETT",
        "first_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-28",
        "certification_date": "2024-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D012262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pleasant Pediatrics PLC (Pleasant Pediatrics)
• Pledge Senior Housing LLC
• Saulius Plenys, RPH
• Susan Lynn Plummer
• Chaveena Plumpe, DPT
• PNC Podiatry of Arizona PC (Desert Foot & Ankle)
• PNC Podiatry of Arizona PC
• Becky Lynne Pockl, N.P.
• Podiatric Physicians Management
• Podiatric Physicians of Arizona, Inc. (Arizona Institute of Footcare Physicians)

• General Practice Dentistry in Mesa, AZ
• Providers in Mesa, 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 28, 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.