Havasu Dental Center PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

HAVASU DENTAL CENTER PLLC

Practice address

2872 Jamaica Blvd S
Lake Havasu City, AZ 86406-7707

Phone

(928) 733-6199

NPI assigned

Mar 21, 2022

Organization subpart

No

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

Authorized official

Name

Tera Niedens

Title

Accountant

Phone

(623) 289-2616

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647820800000",
    "number": "1891444527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34225 N 27TH DR STE 241",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850856091",
            "telephone_number": "623-289-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2872 JAMAICA BLVD S",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864067707",
            "telephone_number": "928-733-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASU DENTAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-21",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A",
        "authorized_official_last_name": "NIEDENS",
        "authorized_official_first_name": "TERA",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "623-289-2616"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "LakeHavasuCity",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2872 Jamaica Blvd S",
            "city": "Lake Havasu City",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "864067707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Hatch, SLP
• Peter Hattar, DMD
• Havasu Behavioral Health, LLC
• Havasu Cardiac Surgery PC
• Havasu Cardiac Surgery PLLC
• Havasu Emergency Physicians, PC
• Havasu Foot & Ankle Center
• Havasu Foot & Ankle Center
• Havasu Health Care Pharm
• Havasu Lung and Sleep Disorders Center LLC

• Dental Clinic/Center in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Dental Clinic/Center in Arizona

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