NPIMap

Organization Active NPI

Parker Dental

  • Clinic/Center
  • Lake Havasu City, AZ
National Provider Identifier
1962056572
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PARKER DENTAL
Practice address
2872 Jamaica Blvd S
Lake Havasu City, AZ 86406-7707
Phone
(928) 733-6199
NPI assigned
Jul 31, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

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

Authorized official

Name
Ilan Shamos, DMDNPI 1851731046
Title
Owner
Phone
(928) 733-6199

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
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2872 Jamaica Blvd S
Lake Havasu City, AZ 86406-7707

Mailing address

2872 Jamaica Blvd S
Lake Havasu City, AZ 86406-7707
Phone (928) 733-6199

Other practice location 1

155 W Riverside Dr Ste 153
Parker, AZ 85344-5221
Phone (928) 669-0099

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Admin

National Provider Directory

National Provider Directory

Locations

155 W Riverside Dr
Ste 153
Parker, AZ 85344
Phone (928) 669-0099

Practitioners & affiliated clinicians

Practitioners 2

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": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1962056572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2872 JAMAICA BLVD S",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864067707",
            "telephone_number": "928-733-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2872 JAMAICA BLVD S",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864067707",
            "telephone_number": "928-733-6199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 W Riverside Dr Ste 153",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "AZ",
            "postal_code": "853445221",
            "country_code": "US",
            "telephone_number": "928-669-0099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PARKER DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "SHAMOS",
        "authorized_official_first_name": "ILAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-733-6199",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Admin",
            "affiliation": "N",
            "address_1": "2872 Jamaica Blvd S",
            "city": "Lake Havasu City",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "864067707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

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