NPIMap

Organization Active NPI

Pueblo del Sol Dental Care LLC

  • General Practice Dentistry
  • Sierra Vista, AZ
National Provider Identifier
1831613934
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D008200 Issued in AZ
Legal business name
PUEBLO DEL SOL DENTAL CARE LLC
Practice address
1900 Paseo San Luis
Sierra Vista, AZ 85635-4614
Phone
(520) 458-2415
Fax
(520) 458-0414
NPI assigned
Jul 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Justin M Israelsen, DMDNPI 1619236742
Title
Owner/Manager/Dentist
Phone
(520) 458-2415

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D008200 AZ Primary

Addresses

Primary practice location

1900 Paseo San Luis
Sierra Vista, AZ 85635-4614

Mailing address

1900 Paseo San Luis
Sierra Vista, AZ 85635-4614
Phone (520) 458-2415

National Provider Directory

National Provider Directory

Locations

1900 Paseo San Luis
Sierra Vista, AZ 85635
Phone (520) 458-2415

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1831613934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 PASEO SAN LUIS",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354614",
            "telephone_number": "520-458-2415",
            "fax_number": "520-458-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 PASEO SAN LUIS",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354614",
            "telephone_number": "520-458-2415",
            "fax_number": "520-458-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO DEL SOL DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ISRAELSEN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/MANAGER/DENTIST",
        "authorized_official_telephone_number": "520-458-2415",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D008200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.