PDA HOLDCO CHANDLER LLC NPI 1811449671

NPI Information

NPI: 1811449671
Provider Name: PDA HOLDCO CHANDLER LLC

Doing Business As: KIDS DENTAL CENTER

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
2900 W RAY RD STE 2
CHANDLER, AZ
ZIP 85224
Phone: (480) 782-5437
Get Directions

PDA HOLDCO CHANDLER LLC is a dental clinic center in Chandler, AZ. PDA HOLDCO CHANDLER LLC NPI is 1811449671. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Kids Dental Center.

The provider's business location address is:

2900 W RAY RD STE 2
CHANDLER, AZ
ZIP 85224-342
Phone: (480) 782-5437
Fax: (480) 857-7888

The provider's authorized official is Jeramy Tarwater .
The authorized official title is President and has the following contact phone number (602) 253-6600.

The enumeration date for this NPI number is 10/27/2016 and was last updated on 2/7/2023.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122300000X	Dentist		8502	ARIZONA	No
2	1223P0221X	Dentist	Pediatric Dentistry			No
3	261QD0000X	Clinic/Center	Dental			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	226988	MEDICAID	ARIZONA

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

NPI Synchronization or Removal

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