NPIMap

Organization Active NPI

Phoenix Pediatric Dental, LLC

  • Pediatric Dentistry
  • Phoenix, AZ
National Provider Identifier
1891875498
Registry record updated Dec 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PHOENIX PEDIATRIC DENTAL, LLC
Practice address
6750 N 19TH Ave
Phoenix, AZ 85015-1127
Phone
(602) 242-5741
Fax
(602) 242-5742
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2014

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

Authorized official

Name
Luz Pacheco
Title
Business Manager
Phone
(602) 242-5741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X AZ Primary

Addresses

Primary practice location

6750 N 19TH Ave
Phoenix, AZ 85015-1127

Mailing address

6750 N 19TH Ave
Phoenix, AZ 85015-1127
Phone (602) 242-5741

Other identifiers 6

IdentifierTypeStateIssuer
409926MedicaidAZ
627562MedicaidAZ
570475MedicaidAZ
883737MedicaidAZ
450924MedicaidAZ
796862MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Compass Point Dental4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419292800000",
    "number": "1891875498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6750 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151127",
            "telephone_number": "602-242-5741",
            "fax_number": "602-242-5742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151127",
            "telephone_number": "602-242-5741",
            "fax_number": "602-242-5742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PEDIATRIC DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2014-12-23",
        "status": "A",
        "authorized_official_last_name": "PACHECO",
        "authorized_official_first_name": "LUZ",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "602-242-5741"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409926",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "627562",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "570475",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883737",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "450924",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "796862",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; 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.