NPIMap

Organization Active NPI

Mohave Dental Associates PC

  • Dentist
  • Kingman, AZ
National Provider Identifier
1942266846
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2714 Issued in AZ
Legal business name
MOHAVE DENTAL ASSOCIATES PC
Practice address
4601 Stockton Hill Road
Kingman, AZ 86409
Phone
(928) 757-3225
Fax
(928) 757-7477
NPI assigned
Apr 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Authorized official

Name
Mr. Clark Earl Melstrom, DDSNPI 1821436387
Title
Owner
Phone
(928) 757-3225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2714 AZ Primary

Addresses

Primary practice location

4601 Stockton Hill Road
Kingman, AZ 86409

Mailing address

4601 Stockton Hill Road
Kingman, AZ 86409
Phone (928) 757-3225

National Provider Directory

National Provider Directory

Locations

4601 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-3225

Practitioners & affiliated clinicians

Practitioners 1

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": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328140800000",
    "number": "1942266846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 STOCKTON HILL ROAD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "86409",
            "telephone_number": "928-757-3225",
            "fax_number": "928-757-7477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 STOCKTON HILL ROAD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "86409",
            "telephone_number": "928-757-3225",
            "fax_number": "928-757-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAVE DENTAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2012-02-02",
        "status": "A",
        "authorized_official_last_name": "MELSTROM",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-757-3225",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "2714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; 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.