NPI |
1841785722 |
The date that a record was last updated or changed. |
Entity Type Code |
2 |
The code designating the provider’s gender if the provider is a person. |
Employer Identification Number EIN |
|
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Organization Name Legal Business Name |
VALUE DENTAL GILBERT LLC |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Other Organization Name |
VALUE DENTAL CENTERS |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
2501 S MARKET ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
GILBERT |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
AZ |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
852951300 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
4806260663 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Enumeration Date |
6/25/2018 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Last Update Date |
6/25/2018 |
|
Authorized Official Last Name |
BIZZARO |
The State code in the location of the provider
being identified. |
Authorized Official First Name |
SEVERN |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Authorized Official Title or Position |
MANAGER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
7024490881 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QD0000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|