Active NPI
Joshua A Mondlick, D.D.S.
- Periodontics
- Peoria, AZ
National Provider Identifier
1790746311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- D6260
- Practice address
- 8671 W Union Hills Dr
Suite 501
Peoria, AZ 85382-7005 - Phone
- (623) 583-3960
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019-026230 | IL | |
| Periodontics | 1223P0300X | D6260 | AZ | Primary |
| Periodontics | 1223P0300X | 053711-1 | NY | |
| Periodontics | 1223P0300X | 28440 | TX |
Addresses
Primary practice location
8671 W Union Hills Dr
Suite 501
Peoria, AZ 85382-7005
Mailing address
8671 W Union Hills Dr
Suite 501
Peoria, AZ 85382-7005
Phone (623) 583-3960
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 877657 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-026230 | IL | MD | Dentist |
| D6260 | AZ | MD | Periodontist |
| 053711-1 | NY | MD | Periodontist |
| 28440 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459814400000",
"number": "1790746311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8671 W UNION HILLS DR",
"address_2": "SUITE 501",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853827005",
"telephone_number": "623-583-3960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8671 W UNION HILLS DR",
"address_2": "SUITE 501",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853827005",
"telephone_number": "623-583-3960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONDLICK",
"first_name": "JOSHUA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2016-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019-026230",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AZ",
"license": "D6260",
"primary": true
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "053711-1",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "28440",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "877657",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.