NPIMap

Organization Active NPI

Mahalo Dental Group LLC

  • Dentist
  • El Mirage, AZ
National Provider Identifier
1992197016
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D5540 Issued in AZ
Legal business name
MAHALO DENTAL GROUP LLC
Practice address
10111 N El Mirage Rd
Suite #4
El Mirage, AZ 85335-3605
Phone
(623) 882-1540
Fax
(623) 882-1300
NPI assigned
Feb 26, 2015
Organization subpart
Yes
Parent organization
EL MIRAGE DENTAL EXCELLENCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Authorized official

Name
Dr. Dan Nydegger, DDS
Title
Owner
Phone
(623) 882-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D5540 AZ Primary

Addresses

Primary practice location

10111 N El Mirage Rd
Suite #4
El Mirage, AZ 85335-3605

Mailing address

10111 N El Mirage Rd
Suite #4
El Mirage, AZ 85335-3605
Phone (623) 882-1540

Other identifiers 1

IdentifierTypeStateIssuer
6196645MedicaidAZ

Other names 1

  • El Mirage Dental Excellence Other name

National Provider Directory

National Provider Directory
Part of
Mahalo Dental Group LLC

NPI Registry JSON

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1992197016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10111 N EL MIRAGE RD",
            "address_2": "SUITE #4",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853353605",
            "telephone_number": "623-882-1540",
            "fax_number": "623-882-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10111 N EL MIRAGE RD",
            "address_2": "SUITE #4",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853353605",
            "telephone_number": "623-882-1540",
            "fax_number": "623-882-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHALO DENTAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EL MIRAGE DENTAL EXCELLENCE",
        "enumeration_date": "2015-02-26",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "NYDEGGER",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-882-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D5540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6196645",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Mirage Dental Excellence",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in El Mirage, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.