Arizona Havasu BDM Pak LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

ARIZONA HAVASU BDM PAK LLC

Doing business as

Bridge Lake Dental

Practice address

1799 North Kiowa Blvd
Unit 109
Lake Havasu, AZ 86403

Phone

(928) 399-7711

Fax

(928) 399-7710

NPI assigned

Oct 13, 2014

Last updated

May 31, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Roland Pischinger

Title

Insurance Department Manager

Phone

(702) 522-2028

Specialties & licenses 1

Addresses

Other names 1

• Bridge Lake Dental Doing business as

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

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527724800000",
    "number": "1912301425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 S JONES BLVD STE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891463133",
            "telephone_number": "702-522-2025",
            "fax_number": "702-990-8856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1799 NORTH KIOWA BLVD",
            "address_2": "UNIT 109",
            "city": "LAKE HAVASU",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-399-7711",
            "fax_number": "928-399-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA HAVASU BDM PAK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2018-05-31",
        "status": "A",
        "authorized_official_last_name": "PISCHINGER",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_title_or_position": "INSURANCE DEPARTMENT MANAGER",
        "authorized_official_telephone_number": "702-522-2028"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridge Lake Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bridge Lake Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Lake Havasu, AZ
• Providers in Lake Havasu, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; 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.