FIESTA KIDS DENTAL LLC (NPI# 1770840951) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770840951 |
| Entity Type | Organization |
| Organization Name | FIESTA KIDS DENTAL LLC |
| Practice Address |
1303 S Longmore Suite #1 Mesa AZ 85202-9607 |
| Practice Telephone | 4807335437 |
| Practice Fax Number | 4807334164 |
| Mailing Telephone | 4807335437 |
| Mailing Fax Number | 4807334164 |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2012-04-12 |
| Authorized Official Name | DR. STEPHEN J MONTOYA (OWNER) |
| Authorized Official Telephone | 4807335437 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
7384 | AZ | Dental Providers |
| Street Address |
1303 S LONGMORE SUITE #1 |
| City | MESA |
| State | AZ |
| Zip Code | 85202-9607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932187630 | David Marshall Cooperman | Obstetrics & Gynecology | 1303 S Longmore, 3, Mesa, AZ 85202 | 2006-01-04 |
| 1689992034 | Brett Allen Butler | Chiropractor | 1303 S Longmore, Suite #8, Mesa, AZ 85202-9607 | 2010-05-10 |
| 1730264318 | Michael David Margolis | Dentist | 1303 S Longmore, Suite 1, Mesa, AZ 85202-9607 | 2006-10-25 |
| 1548353238 | Thomas C. Cheney | Optometrist | 1303 S Longmore, Suites 2 and 3, Mesa, AZ 85202-9607 | 2006-10-02 |
| 1407872930 | Clint Bennion | Chiropractor | 1303 S Longmore, Suite #8, Mesa, AZ 85202-9607 | 2006-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275173536 | Samuel A Wolde | Counselor | Clear View Counseling, 2651 W Guadalupe Rd, Mesa, AZ 85202 | 2020-01-14 |
| 1912549171 | Lauren Barbara Loges | Occupational Therapist | 2225 E. Southern Avenue, Mesa, AZ 85202 | 2019-10-09 |
| 1245724822 | Medsource Orthotics & Prosthetics, Inc | Prosthetic/Orthotic Supplier | 1450 S Dobson Rd Ste B326, Mesa, AZ 85202 | 2018-06-18 |
| 1457843310 | Jay Douglas Baumgardner | Physical Therapist | 1941 W. Guadalupe Rd. Suite 109, Mesa, AZ 85202 | 2018-06-05 |
| 1144746215 | Alyson Fix | Physician Assistant | 1432 S Dobson Rd Ste 304, Mesa, AZ 85202 | 2017-08-20 |
| 1194108852 | Robert Dale Labrum | Counselor | 1255 W Baseline Rd Ste B-258, Mesa, AZ 85202 | 2015-06-30 |
| 1114325677 | John David Shull Jr. | Physician Assistant | 1520 S Dobson Rd Ste 305, Mesa, AZ 85202 | 2014-12-16 |
| 1316356207 | Embry Womens Health LLC | Nurse Practitioner | 2204 S Dobson Road, Suite 203, Mesa, AZ 85202 | 2014-08-05 |
| 1619312899 | Fiza Naueed Khan | Internal Medicine | 1400 South Dobson Road, Attn: Bmg Hospitalists Team/amanda Gump, Mesa, AZ 85202 | 2013-05-01 |
| 1487903373 | Jodi Lynn Mealer | Pharmacist | 1951 W. Baseline Rd., Mesa, AZ 85202 | 2012-09-06 |
| Find all providers in zip 85202 | ||||
| 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 |
| 1407344567 | Kids Dental Group Pllc | Dentist | 6239 E Brown Rd Ste 102, Mesa, AZ 85205-4933 | 2018-04-24 |
| 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 |
| 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.