Mobile Dentistry of Az, LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

MOBILE DENTISTRY OF AZ, LLC

Practice address

2733 N Power Rd Ste 102-449
Mesa, AZ 85215-1758

Phone

(480) 313-3310

Fax

(480) 772-4032

NPI assigned

Oct 19, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Ann Ross, RDH

Title

Owner

Phone

(480) 313-3310

Specialties & licenses 6

Addresses

Practitioners 1

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

• Josie Gemarie de Leon Oliva, DDS

  • General Practice Dentistry
  • San Tan Valley, AZ
  • NPI 1134357577
  NPD (past)

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

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1871846436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2733 N POWER RD STE 102-449",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852151758",
            "telephone_number": "480-313-3310",
            "fax_number": "480-772-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2733 N POWER RD STE 102-449",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852151758",
            "telephone_number": "480-313-3310",
            "fax_number": "480-772-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE DENTISTRY OF AZ, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-19",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-313-3310",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Mitten, FNP-C
• Candace Miyatani, BHT, BS, MA
• MJW Ventures
• Mo Medtrans, LLC
• Kayla Marie Moberg, COTA/L
• Mobile Medical Providers of Arizona, LLC
• Mobilecaremd LLC
• Modern Ambulatory Surgery Center, PC
• Modern Dental Professionals - Arizona PC
• Modern Diagnostic Imaging, P.C.

• Custodial Care Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Custodial Care Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; 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.