KIDS DENTAL GROUP PLLC (NPI# 1407344567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407344567 |
| Entity Type | Organization |
| Organization Name | KIDS DENTAL GROUP PLLC |
| Other Organization Name | MESA PEDIATRIC DENTISTRY |
| Practice Address |
6239 E Brown Rd Ste 102 Mesa AZ 85205-4933 |
| Mailing Address |
6025 N 27th Ave Ste 25 Phoenix AZ 85017-1765 |
| Practice Telephone | 4803963660 |
| Mailing Telephone | 6025959199 |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2018-04-24 |
| Authorized Official Name | DR. DANIEL PONCE (OWNER) |
| Authorized Official Telephone | 6462346578 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Mesa Pediatric Dentistry | Doing Business As Name - Organization |
| Street Address |
6239 E BROWN RD STE 102 |
| City | MESA |
| State | AZ |
| Zip Code | 85205-4933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083130199 | Rose Campbell | Technician/Technologist | 649 North Orlando, Mesa, AZ 85205 | 2017-08-21 |
| 1528459781 | Elizabeth Sadler | Nurse Practitioner | 4434 E Brown Rd Ste 102, Mesa, AZ 85205 | 2015-02-10 |
| 1326444324 | Katherine G Perez | Counselor | 152 N Power Rd Ste 2, Mesa, AZ 85205 | 2014-11-18 |
| 1831500800 | C.b.o Hearing | Hearing Aid Equipment | 4406 E. Main St, Suite 103, Mesa, AZ 85205 | 2014-05-13 |
| 1699195107 | Amanda Mcdaniel | Occupational Therapist | 5911 E. Fountain St., Mesa, AZ 85205 | 2014-04-23 |
| 1952640278 | Medstar Medical Transportation LLC | Non-emergency Medical Transport (VAN) | 3932 E Fairfield Cir, Mesa, AZ 85205 | 2013-02-06 |
| 1245575398 | Fabulous Smiles of Mesa | Dentist | 4434 E. Brown Rd, Ste 104, Mesa, AZ 85205 | 2012-11-30 |
| 1992087639 | Matthew Robert Millward | Pharmacist | 1935 N. Power Rd, Mesa, AZ 85205 | 2011-09-19 |
| 1740596733 | Arizona Family & Geriatric Medicine Pllc | Clinic/Center | 5602 E. Main St., Mesa, AZ 85205 | 2010-08-27 |
| 1295049609 | Thomas Chambers | Podiatrist | 5520 E Main St Ste 2, Mesa, AZ 85205 | 2010-07-28 |
| Find all providers in zip 85205 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033750724 | Mesa Valley Dental LLC | Dentist | 1220 S Higley Rd Ste 206, Mesa, AZ 85206-4002 | 2019-10-03 |
| 1942841663 | Mesa Kidtastic Dental LLC | Dentist | 1240 W Southern Ave Ste 112, Mesa, AZ 85202-4882 | 2019-10-03 |
| 1194200980 | Highbury Dental Management, LLC | Dentist | 4425 S Mountain Rd, Suite 109, Mesa, AZ 85212 | 2018-09-27 |
| 1861841918 | Ryan Blake | Dentist | 4425 S. Mountain Road, Ste 109, Mesa, AZ 85212 | 2016-06-09 |
| 1215281688 | Fiesta Kidtastic, LLC | Dentist | 1303 S Longmore Ste 1, Mesa, AZ 85202-9607 | 2012-11-06 |
| 1770831430 | Brian Glen Banks | Dentist | 2500 S Power Rd Ste 128, Mesa, AZ 85209 | 2012-08-28 |
| 1477811842 | Kids Dental Specialists LLC | Dentist | 1305 S Alma School Rd, Mesa, AZ 85210-2070 | 2012-04-24 |
| 1508178898 | John William Taylor | Dentist | 4540 E. Baseline Rd, Suite 102, Mesa, AZ 85206 | 2010-07-02 |
| 1245411644 | John W. Taylor, Dds, Pllc | Dentist | 4540 E Baseline Rd., Ste. 102, Mesa, AZ 85206 | 2007-11-14 |
| 1245450469 | Cory Giles | Dentist | 1635 N Greenfield Rd Ste 111, Mesa, AZ 85205-4010 | 2007-04-27 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.