1124105291 NPI number — DENTAL ONE, INC.

Table of content: (NPI 1124105291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124105291 NPI number — DENTAL ONE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL ONE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DENTAL GROUP OF AHWATUKEE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124105291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-893-0888
Provider Business Mailing Address Fax Number:
216-584-1301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10827 S. 51ST ST.
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85044-4310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-893-0888
Provider Business Practice Location Address Fax Number:
216-584-1301
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, RCM
Authorized Official Telephone Number:
972-930-7707

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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