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MOUNTAIN PARK DENTISTRY L.L.C. NPI 1457719114


NPI Information

NPI: 1457719114
Provider Name: MOUNTAIN PARK DENTISTRY L.L.C.
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

CLIA Number: 03D2075031

Address:
15215 S 48TH ST STE 175
PHOENIX, AZ
ZIP 85044
Phone: (480) 759-9300
Get Directions

MOUNTAIN PARK DENTISTRY L.L.C. 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. MOUNTAIN PARK DENTISTRY L.L.C. NPI is 1457719114. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

15215 S 48TH ST STE 175
PHOENIX, AZ
ZIP 85044-140
Phone: (480) 759-9300
Fax: (480) 759-2130

The provider's authorized official is Randy Mow .
The authorized official title is Owner and has the following contact phone number (480) 759-9300.

The CLIA number assigned to this NPI record is 03D2075031 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/9/2016 and was last updated on 2/9/2016.


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
11223P0300XDentistPeriodonticsNo
21223G0001XDentistGeneral PracticeYes

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: 5/5/2024

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