Pda Holdco Chandler LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PDA HOLDCO CHANDLER LLC

Doing business as

Kids Dental Center

Practice address

2900 W Ray Rd Ste 2
Chandler, AZ 85224-7342

Phone

(480) 782-5437

Fax

(480) 857-7888

NPI assigned

Oct 27, 2016

Last updated

Feb 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeramy Tarwater

Title

President

Phone

(602) 253-6600

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Kids Dental Center Doing business as

Locations

Practitioners 2

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.

• Rassa Abdollahzadeh, D.M.D.

  • Pediatric Dentistry
  • Gilbert, AZ
  • NPI 1225074040
  NPD (past)
• Romona L. Davis, DDS

  • Pediatric Dentistry
  • Chandler, AZ
  • NPI 1679517163
  NPD (past)

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1811449671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 W RAY RD STE 2",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852247342",
            "telephone_number": "480-782-5437",
            "fax_number": "480-857-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 W RAY RD STE 2",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852247342",
            "telephone_number": "480-782-5437",
            "fax_number": "480-857-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDA HOLDCO CHANDLER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "TARWATER",
        "authorized_official_first_name": "JERAMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-253-6600"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "8502",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226988",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan Robert Pauly, M.P.T
• Scott Pavuk, RPH
• Rebecca Joanne Paxton, MD
• Daysi Estefania Payan
• Grace Payton
• Peace of Mind Dental PLLC
• Peach Tree PT & Wellness, LLC
• Gregory Allen Peacock, D.C.
• Julia Peairs, PT, DPT
• Alaina Nichole Pearl

• Dental Clinic/Center in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.