Marketside Street Dental LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MARKETSIDE STREET DENTAL LLC

Doing business as

Sun Valley Pediatric Dentistry-Verrado

Practice address

20800 W Market St Ste 103
Buckeye, AZ 85396-8040

Phone

(623) 401-9440

NPI assigned

Aug 25, 2022

Last updated

Sep 29, 2022By 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

Jenny Garcia

Title

Credentialing Lead

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Sun Valley Pediatric Dentistry-Verrado Doing business as

Locations

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

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1952020612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734753",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753734753",
            "telephone_number": "623-401-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20800 W MARKET ST STE 103",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853968040",
            "telephone_number": "623-401-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARKETSIDE STREET DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-25",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "CREDENTIALING LEAD",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sun Valley Pediatric Dentistry-Verrado",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sun Valley Pediatric Dentistry-Verrado",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deborah R Mackenzie, DDS
• Main Street Medical
• Monica Renee Malmgren, M.S. CCC-SLP
• Karyn Manning
• Marketplace Dentistry, LLP (Marketplace Dentistry)
• Indira Markowski
• Brandon Arnold Marschman, PT, DPT
• Eleanor Sue Marschman
• Michael Marshall, PSY.D.
• Angie Jasmine Martinez

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.