Verde Dental Care, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3089 Issued in AZ

Legal business name

VERDE DENTAL CARE, LLC

Practice address

522 W Finnie Flats Rd
Ste J
Camp Verde, AZ 86322-7265

Phone

(928) 567-5249

NPI assigned

Feb 3, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Eric A Pettersen, D.M.D.NPI 1710903299

Title

Member

Phone

(928) 567-5249

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric Pettersen, D.M.D.

  • General Practice Dentistry
  • Camp Verde, AZ
  • NPI 1710903299
  NPD (past) Authorized official
• Michael Thomas Hughes, DDS

  • General Practice Dentistry
  • Camp Verde, AZ
  • NPI 1154414142
  NPD (past)
• Shawn Kinney, DMD

  • General Practice Dentistry
  • Camp Verde, AZ
  • NPI 1720430473
  NPD (past)

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265155200000",
    "number": "1992037857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 788",
            "city": "CAMP VERDE",
            "state": "AZ",
            "postal_code": "863220788",
            "telephone_number": "928-567-5249",
            "fax_number": "928-567-0430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 W FINNIE FLATS RD",
            "address_2": "STE J",
            "city": "CAMP VERDE",
            "state": "AZ",
            "postal_code": "863227265",
            "telephone_number": "928-567-5249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERDE DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2010-02-03",
        "status": "A",
        "authorized_official_last_name": "PETTERSEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "928-567-5249",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D3089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stella Torshie Squire
• Steven Jared Taylor, D.O.
• Jon Thompson, LMT
• Michael Eugene Turner, DC
• Victor Rafael Vellon, DDS
• Verde Massage LLC
• Verde Vista Care and Rehab, Inc
• Walgreen Co
• Deborah A Wasson, FNP
• Brian Wattenbarger

• General Practice Dentistry in Camp Verde, AZ
• Providers in Camp Verde, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.