NPIMap

Organization Active NPI

Prescott Valley Dental Group, LLP

  • Dentist
  • Prescott Valley, AZ
National Provider Identifier
1932518404
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PRESCOTT VALLEY DENTAL GROUP, LLP
Doing business as
PRESCOTT VALLEY DENTAL GROUP
Practice address
3264 Glassford Hill Road, Ste. a
Prescott Valley, AZ 86314
Phone
(928) 759-8000
NPI assigned
Aug 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Authorized official

Name
Dr. Darren L Line, DDS
Title
Owner
Phone
(928) 759-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

3264 Glassford Hill Road, Ste. a
Prescott Valley, AZ 86314

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • PRESCOTT VALLEY DENTAL GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

3264 N Glassford Hill Rd
Ste A
Prescott Valley, AZ 86314
Phone (928) 759-8000

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1932518404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 GLASSFORD HILL ROAD, STE. A",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "86314",
            "telephone_number": "928-759-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT VALLEY DENTAL GROUP, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-08",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "LINE",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-759-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRESCOTT VALLEY DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRESCOTT VALLEY DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; 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.