Pda Holdco, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PDA HOLDCO, LLC

Practice address

1457 W Southern Ave Ste 18
Mesa, AZ 85202-4853

Phone

(480) 610-2300

Fax

(480) 833-0682

NPI assigned

Jan 12, 2012

Organization subpart

Yes

Parent organization

PDA HOLDINGSAs reported in NPPES

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

Authorized official

Name

Daniel Morrissey

Title

President

Phone

(602) 253-6600

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Magic Smiles Dental Doing business as
• Magic Smiles Dental Care Doing business as

Part of

Pda Holdings LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Pda Holdings, LLC

  • Dental Clinic/Center
  • Phoenix, AZ
  • NPI 1134345937
  NPPES parent name

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1821369455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E THOMAS RD",
            "address_2": "SUITE #204",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167646",
            "telephone_number": "602-253-6600",
            "fax_number": "602-279-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1457 W SOUTHERN AVE STE 18",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024853",
            "telephone_number": "480-610-2300",
            "fax_number": "480-833-0682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDA HOLDCO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PDA HOLDINGS",
        "enumeration_date": "2012-01-12",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "MORRISSEY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-253-6600"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D5504",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "670703",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magic Smiles Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magic Smiles Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magic Smiles Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin Scott Payne, PA-S1
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• Dental Clinic/Center in Mesa, AZ
• Providers in Mesa, 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.