Paradise Ridge Family Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PARADISE RIDGE FAMILY DENTISTRY LLC

Doing business as

Paradise Ridge Family Dentistry

Practice address

15433 N Tatum Blvd Ste 200
Phoenix, AZ 85032-4228

Phone

(602) 755-4691

NPI assigned

Mar 21, 2024

Last updated

Mar 21, 2024By 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

Rodney Clark Tilley

Title

Owner/GM

Phone

(602) 695-4192

Specialties & licenses 1

Addresses

Other names 1

• Paradise Ridge Family Dentistry Doing business as

Locations

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

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710979200000",
    "number": "1841050267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16627 S LINDSAY RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951501",
            "telephone_number": "602-695-4192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15433 N TATUM BLVD STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850324228",
            "telephone_number": "602-755-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADISE RIDGE FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-21",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A",
        "authorized_official_last_name": "TILLEY",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "OWNER/GM",
        "authorized_official_telephone_number": "602-695-4192"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paradise Ridge Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Paradise Valley Allergy Assoc LTD
• Paradise Valley Behavioral Health

• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, 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 Mar 21, 2024; 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.