Dr. Leonard Bafaloukos D.D.S.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

1523 Issued in AZ

Legal business name

DR. LEONARD BAFALOUKOS D.D.S.

Practice address

3902 W Camelback Rd
Phoenix, AZ 85019-5824

Phone

(602) 841-5473

Fax

(602) 841-8640

NPI assigned

Jun 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Leonard Bafaloukos, D.D.S.NPI 1700969664

Title

Owner

Phone

(602) 841-5473

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Leonard Bafaloukos, D.D.S.

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1700969664
  NPD (past) Authorized official

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902000656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 W CAMELBACK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850195824",
            "telephone_number": "602-841-5473",
            "fax_number": "602-841-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 W CAMELBACK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850195824",
            "telephone_number": "602-841-5473",
            "fax_number": "602-841-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. LEONARD BAFALOUKOS D.D.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAFALOUKOS",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-841-5473",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "1523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "803093",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0493590",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Phoenix, AZ
• Providers in Phoenix, 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 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.