Maricopa Dental Center LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MARICOPA DENTAL CENTER LLC

Practice address

21300 N John Wayne Pkwy Ste 128
Maricopa, AZ 85139-8978

Phone

(520) 568-5959

NPI assigned

Sep 12, 2022

Organization subpart

No

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

Authorized official

Name

Tera Niedens

Title

Accountant

Phone

(623) 289-2616

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1992427538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34225 N 27TH DR STE 241",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850856091",
            "telephone_number": "623-289-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 N JOHN WAYNE PKWY STE 128",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851398978",
            "telephone_number": "520-568-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARICOPA DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "NIEDENS",
        "authorized_official_first_name": "TERA",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "623-289-2616"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Maricopa",
            "affiliation": "N",
            "address_1": "21300 N John Wayne Pkwy Ste 128",
            "city": "Maricopa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "851398978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dental Clinic/Center in Maricopa, AZ
• Providers in Maricopa, 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 Sep 12, 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.

Verify at the official NPI Registry.