NPIMap

Individual provider Active NPI

Umar M Imtiaz, D.D.S., M.S.

  • Pediatric Dentistry
  • Buckeye, AZ
National Provider Identifier
1871595983
Registry record updated Jul 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
7256 Issued in AZ
Practice address
23374 W Yuma Rd Ste 102
Buckeye, AZ 85326-3120
Phone
(978) 328-2886
Fax
(623) 444-6745
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 051498 NY
Pediatric Dentistry 1223P0221X 7256 AZ Primary

Addresses

Primary practice location

23374 W Yuma Rd Ste 102
Buckeye, AZ 85326-3120

Mailing address

23374 W Yuma Rd Ste 102
Buckeye, AZ 85326-3120
Phone (623) 444-9999

Other identifiers 1

IdentifierTypeStateIssuer
225122MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
051498NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivy 2 Dental PLLC Pediatric Dentistry Past Accepting new patients
Ivy 2 Dental PLLC Dentist Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1871595983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23374 W YUMA RD STE 102",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853263120",
            "telephone_number": "623-444-9999",
            "fax_number": "623-444-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23374 W YUMA RD STE 102",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853263120",
            "telephone_number": "978-328-2886",
            "fax_number": "623-444-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMTIAZ",
        "first_name": "UMAR",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051498",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "7256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225122",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckeye, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.