Active NPI
Michael Greg Nadauld, DMD
- Dentist
- Phoenix, AZ
National Provider Identifier
1972986263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 010962
- Practice address
- 1526 W Glendale Ave Ste 102
Phoenix, AZ 85021-8576 - Phone
- (602) 995-7279
- Fax
- (602) 995-7244
- NPI assigned
- Jul 4, 2015
- Reactivated
- Apr 28, 2021
- Last updated
- Jul 29, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 010962 | AZ | Primary |
| Dentist | 122300000X | 9593673 | UT |
Addresses
Primary practice location
1526 W Glendale Ave Ste 102
Phoenix, AZ 85021-8576
Mailing address
1526 W Glendale Ave Ste 102
Phoenix, AZ 85021-8576
Phone (602) 995-7279
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010962 | AZ | MD | Dentist |
| 9593673 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael G. Nadauld, DMD PLLC | Current | Accepting new patients | |
| PDC- Lehi Utah | General Practice | Past | Accepting new patients |
Locations
1526 W Glendale Ave
Ste 102
Phoenix, AZ 85021
Phone (602) 995-0114
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659052800000",
"number": "1972986263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1526 W GLENDALE AVE STE 102",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850218576",
"telephone_number": "602-995-7279",
"fax_number": "602-995-7244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1526 W GLENDALE AVE STE 102",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850218576",
"telephone_number": "602-995-7279",
"fax_number": "602-995-7244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NADAULD",
"first_name": "MICHAEL",
"middle_name": "GREG",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-04",
"last_updated": "2022-07-29",
"certification_date": "2022-07-29",
"deactivation_date": "2021-03-31",
"reactivation_date": "2021-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "010962",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "9593673",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.