Mesa Kidtastic Dental LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MESA KIDTASTIC DENTAL LLC

Practice address

1240 W Southern Ave Ste 112
Mesa, AZ 85202-4882

Phone

(403) 733-5437

NPI assigned

Oct 3, 2019

Organization subpart

No

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

Authorized official

Name

Faith Gaskins

Title

Director of Credentialing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1942841663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 W SOUTHERN AVE STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024882",
            "telephone_number": "403-733-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 W SOUTHERN AVE STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024882",
            "telephone_number": "403-733-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA KIDTASTIC DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; 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.