South Mountain Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTH MOUNTAIN DENTAL LLC

Doing business as

South Mountain Family Dental

Practice address

2233 W Baseline Rd Ste 104
Tempe, AZ 85283-1097

Phone

(602) 438-9245

NPI assigned

Oct 18, 2021

Last updated

Oct 18, 2021By 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

Faith Gaskins

Title

Director of Credentailing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• South Mountain Family Dental 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.

• Michael Shumway Dickerson, D.M.D.

  • General Practice Dentistry
  • Tempe, AZ
  • NPI 1619225307
  NPD (past)
• Gregory Louis Teneyck, D.D.S.

  • General Practice Dentistry
  • Tempe, AZ
  • NPI 1184622953
  NPD (past)

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1821751777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 W BASELINE RD STE 104",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852831097",
            "telephone_number": "602-438-9245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 W BASELINE RD STE 104",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852831097",
            "telephone_number": "602-438-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTAILING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Mountain Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Soricone
• Alejandra Soto, RBT
• Theodore Lawrence Sottosanti, PHARMD
• Soul West Services LLC (Soul West Services)
• Sourceone Medical Inc
• South Tempe ER LLC
• Southern Avenue Family Practice, PC
• Southern Desert Internal Medicine PC
• Sean Southland, PHD, MDAST, CBIS
• Southwest Anesthesia PLLC

• General Practice Dentistry in Tempe, AZ
• Providers in Tempe, 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 Oct 18, 2021; 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.