Kevin T Axx, DDS
Individual provider Active NPI Endodontics · Phoenix, AZ
NPI 1831294032 · NPPES record last updated Aug 24, 2010
Key facts
- NPI
- 1831294032
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- D7377 (AZ)
- Practice address
- 4141 N 32ND St Ste 100
Phoenix, AZ 85018-4775 - Phone
- (602) 667-3600
- Fax
- (602) 667-3611
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160225000555 | AZ | Order and Referring Only - Other (Physician) |
8123323359 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7377 | AZ | MD | Endodontist |
| DS036316 | PA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arcadia Endodontic Partners PLLC | Endodontics | Current | Accepting new patients |
| North Valley Endodontics, P.a. | Endodontics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 050281 | NY | |
| Endodontics | 1223E0200X | D7377 | AZ | Yes |
| Endodontics | 1223E0200X | DS036316 | PA |
Addresses
Primary practice location
4141 N 32ND St Ste 100
Phoenix, AZ 85018-4775
Mailing address
1 E Lexington Ave Unit 1010
Phoenix, AZ 85012-2494
Phone (602) 667-3600
Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.