NPIMap

Organization Active NPI

Cosmetic Family Dental Clinic PC

  • Dentist
  • Mesa, AZ
National Provider Identifier
1770609000
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5118 Issued in AZ
Legal business name
COSMETIC FAMILY DENTAL CLINIC PC
Practice address
1236 E Baseline Rd
#103
Mesa, AZ 85204-6705
Phone
(480) 503-3600
Fax
(480) 503-3601
NPI assigned
Mar 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Nick Nam Huynh, DDSNPI 1619075850
Title
Owner Dentist
Phone
(480) 503-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5118 AZ Primary

Addresses

Primary practice location

1236 E Baseline Rd
#103
Mesa, AZ 85204-6705

Mailing address

1236 E Baseline Rd
#103
Mesa, AZ 85204-6705
Phone (480) 503-3600

National Provider Directory

National Provider Directory

Locations

1236 E Baseline Rd
Ste 103
Mesa, AZ 85204
Phone (480) 503-3600

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770609000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 E BASELINE RD",
            "address_2": "#103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046705",
            "telephone_number": "480-503-3600",
            "fax_number": "480-503-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 E BASELINE RD",
            "address_2": "#103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046705",
            "telephone_number": "480-503-3600",
            "fax_number": "480-503-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC FAMILY DENTAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUYNH",
        "authorized_official_first_name": "NICK",
        "authorized_official_middle_name": "NAM",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "480-503-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "5118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.