NPIMap

Organization Active NPI

Anthem Periodontics and Dental Implants

  • Periodontics
  • Henderson, NV
National Provider Identifier
1861942625
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
6797 Issued in NV
Legal business name
ANTHEM PERIODONTICS AND DENTAL IMPLANTS
Practice address
2610 W Horizon Ridge Pkwy
#202
Henderson, NV 89052-2869
Phone
(702) 270-4600
Fax
(702) 270-7773
NPI assigned
Oct 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Dr. Ed Deandrade, DDS
Title
Owner
Phone
(702) 270-4600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 6797 NV Primary

Addresses

Primary practice location

2610 W Horizon Ridge Pkwy
#202
Henderson, NV 89052-2869

Mailing address

2610 W Horizon Ridge Pkwy
#202
Henderson, NV 89052-2869

National Provider Directory

National Provider Directory
Tax ID family
Anthem Periodontics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1861942625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 W HORIZON RIDGE PKWY",
            "address_2": "#202",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 W HORIZON RIDGE PKWY",
            "address_2": "#202",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522869",
            "telephone_number": "702-270-4600",
            "fax_number": "702-270-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHEM PERIODONTICS AND DENTAL IMPLANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "DEANDRADE",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-270-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NV",
            "license": "6797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.