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PDA HOLDCO LLC NPI 1821369455


NPI Information

NPI: 1821369455
Provider Name: PDA HOLDCO, LLC

Doing Business As: MAGIC SMILES DENTAL

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

Specialization: Dental

Address:
1457 W SOUTHERN AVE STE 18
MESA, AZ
ZIP 85202
Phone: (480) 610-2300
Get Directions

PDA HOLDCO, LLC is a dental clinic center in Mesa, AZ. PDA HOLDCO, LLC NPI is 1821369455. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Magic Smiles Dental.

The provider's business location address is:

1457 W SOUTHERN AVE STE 18
MESA, AZ
ZIP 85202-853
Phone: (480) 610-2300
Fax: (480) 833-0682

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

The enumeration date for this NPI number is 1/12/2012 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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1122300000XDentistD5504ARIZONANo
2261QD0000XClinic/CenterDentalYes

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
1670703MEDICAIDARIZONA

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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