Active NPI
Gregory Whelan, DMD
- Pediatric Dentistry
- Peoria, AZ
National Provider Identifier
1912095126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 7471
- Practice address
- 9840 W Yearling Rd
#1240
Peoria, AZ 85383-1377 - Phone
- (623) 572-9300
- NPI assigned
- Oct 11, 2006
- Last updated
- Aug 24, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 015095 | MO | |
| Pediatric Dentistry | 1223P0221X | 7471 | AZ | Primary |
Addresses
Primary practice location
9840 W Yearling Rd
#1240
Peoria, AZ 85383-1377
Mailing address
9840 W Yearling Rd
#1240
Peoria, AZ 85383-1377
Phone (623) 572-9300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015095 | MO | MD | Pediatric Dentist |
| 7471 | AZ | MD | Registered Respiratory Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pleasant Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Point of Service
- Peoria, AZ
- NPI 1396137923
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1912095126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9840 W YEARLING RD",
"address_2": "#1240",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853831377",
"telephone_number": "623-572-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9840 W YEARLING RD",
"address_2": "#1240",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853831377",
"telephone_number": "623-572-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHELAN",
"first_name": "GREGORY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MO",
"license": "015095",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "AZ",
"license": "7471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.