NPIMap

Organization Active NPI

E Pell Wadleigh DDS PC

  • Family Medicine Physician
  • Page, AZ
National Provider Identifier
1891817615
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2639 Issued in AZ
Legal business name
E PELL WADLEIGH DDS PC
Practice address
436 Vista Ave
Page, AZ 86040-0002
Phone
(928) 645-2505
Fax
(928) 645-6820
NPI assigned
Apr 4, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Eric Pell Wadleigh, DDSNPI 1639242969
Title
Owner
Phone
(928) 645-2505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2639 AZ Primary

Addresses

Primary practice location

436 Vista Ave
Page, AZ 86040-0002

Mailing address

PO Box 2
436 Vista Ave
Page, AZ 86040-0002
Phone (928) 645-2505

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891817615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2",
            "address_2": "436 VISTA AVE",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860400002",
            "telephone_number": "928-645-2505",
            "fax_number": "928-645-6820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 VISTA AVE",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860400002",
            "telephone_number": "928-645-2505",
            "fax_number": "928-645-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E PELL WADLEIGH DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WADLEIGH",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "PELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-645-2505",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "2639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Page, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.