Laveen Pediatric Dental Partners, LLP

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

LAVEEN PEDIATRIC DENTAL PARTNERS, LLP

Practice address

5235 W. Baseline Rd, Ste 187
Laveen, AZ 85339

Phone

(602) 883-8649

Fax

(602) 744-8778

NPI assigned

May 31, 2016

Organization subpart

No

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

Authorized official

Name

Eric E Ellis, DMD

Title

Owner Doctor

Phone

(602) 883-8649

Specialties & licenses 1

Addresses

Other names 1

• Laveen Kid's Dentist and Orthodontics Doing business as

Locations

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1962850073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8656",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5235 W. BASELINE RD, STE 187",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "85339",
            "telephone_number": "602-883-8649",
            "fax_number": "602-744-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVEEN PEDIATRIC DENTAL PARTNERS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "602-883-8649",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laveen Kid's Dentist and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; 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.