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CHILDREN'S MEDICAID DENTAL CLINIC PC NPI 1326025974


NPI Information

NPI: 1326025974
Provider Name: CHILDREN'S MEDICAID DENTAL CLINIC, PC

Doing Business As: CHILDREN'S DENTAL CLINIC OF W. THOMAS RD.

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

CLIA Number: 06D0967615

Address:
5115 W THOMAS RD
PHOENIX, AZ
ZIP 85031
Phone: (602) 233-3133
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CHILDREN'S MEDICAID DENTAL CLINIC, PC is a general practice dentist in Phoenix, AZ. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. CHILDREN'S MEDICAID DENTAL CLINIC, PC NPI is 1326025974. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Children's Dental Clinic Of W. Thomas Rd..

The provider's business location address is:

5115 W THOMAS RD
PHOENIX, AZ
ZIP 85031-944
Phone: (602) 233-3133
Fax: (602) 278-3139

The provider's authorized official is Trudy Williams .
The authorized official title is Director, Licensing & Credentialing and has the following contact phone number (615) 750-0342.

The CLIA number assigned to this NPI record is 06D0967615 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/26/2005 and was last updated on 5/17/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1619661MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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