Dr Wisdom Teeth

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D009399 Issued in AZ

Legal business name

DR WISDOM TEETH

Practice address

287 E Hunt Hwy Ste 101
San Tan Valley, AZ 85143-5096

Phone

(833) 394-7366

NPI assigned

Jun 8, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Fenn, DMDNPI 1427460575

Title

Owner

Phone

(702) 325-7627

Specialties & licenses 1

Addresses

Other names 1

• Dr Wisdom Teeth Doing business as

Practitioners 1

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

• Jeffrey Fenn, DMD

  • Dentist
  • Lubbock, TX
  • NPI 1427460575
  NPD Authorized official

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1992298533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "287 E HUNT HWY STE 101",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851435096",
            "telephone_number": "833-394-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "287 E HUNT HWY STE 101",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851435096",
            "telephone_number": "833-394-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR WISDOM TEETH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-08",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "FENN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-325-7627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "D009399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Wisdom Teeth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Derek Dickson, PHARMD
• Victoria Ann Diforte-Corona, M.ED., BCBA, LBA, IB
• DO for Love LLC
• Vanessa Marin Dockery, FNP-BC
• Heather Lee Dowler, RN
• Anthony Jon Drew, O.D.
• Nancy May Dryden, COTA/L
• Dani Duffy
• Kirk Duxbury, DC
• Kevin Earlywine, PA-C

• Dental Clinic/Center in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; 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.