ARIZONA HAVASU BDM PAK LLC (NPI# 1912301425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912301425 |
| Entity Type | Organization |
| Organization Name | ARIZONA HAVASU BDM PAK LLC |
| Other Organization Name | BRIDGE LAKE DENTAL |
| Practice Address |
1799 North Kiowa Blvd Unit 109 Lake Havasu AZ 86403 |
| Mailing Address |
2101 S Jones Blvd Ste 140 Las Vegas NV 89146-3133 |
| Practice Telephone | 9283997711 |
| Practice Fax Number | 9283997710 |
| Mailing Telephone | 7025222025 |
| Mailing Fax Number | 7029908856 |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2018-05-31 |
| Authorized Official Name | ROLAND PISCHINGER (INSURANCE DEPARTMENT MANAGER) |
| Authorized Official Telephone | 7025222028 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | Dental Providers |
| Other Name | Type Code |
|---|---|
| Bridge Lake Dental | Doing Business As Name - Organization |
| Street Address |
1799 NORTH KIOWA BLVD UNIT 109 |
| City | LAKE HAVASU |
| State | AZ |
| Zip Code | 86403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| 1114200664 | House On The Riviera Assisted Living | Assisted Living Facility | 190 Riviera Dr., Lake Havasu City, AZ 86403 | 2011-09-21 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407456031 | Roger Ryan Roybal, Dds, Pllc | Dentist | 14300 N Northsight Blvd Ste 214, Scottsdale, AZ 85260-3677 | 2020-11-01 |
| 1851990444 | Shaveta Behl | Dentist | 320 E Mcdowell Rd Ste 221, Phoenix, AZ 85004-4516 | 2020-10-23 |
| 1083212575 | Rasha Adil Abduljabbar Al-kaabi | Dentist | 4750 E Union Hills Dr Apt 1076, Phoenix, AZ 85050-3366 | 2020-10-15 |
| 1124625793 | Gilbert Crossroads Kids' Dentists and Orthodontics, LLP | Dentist | 835 S. Gilbert Rd, Suite 104, Gilbert, AZ 85296 | 2020-10-06 |
| 1750998969 | Christie Jacques | Dentist | 7410 E Sutton Dr, Scottsdale, AZ 85260-3915 | 2020-09-30 |
| 1447865480 | Luke Michael Mangelsdorf | Dentist | 2249 Hualapai Mountain Rd Ste 1, Kingman, AZ 86401-8321 | 2020-09-15 |
| 1386258689 | Joshua Dutton | Dentist | 8325 W Happy Valley Rd Unit 100, Peoria, AZ 85383-4361 | 2020-09-03 |
| 1912510678 | Nicholas Ahn | Dentist | 1550 E Campbell Ave Apt 3028, Phoenix, AZ 85014-4271 | 2020-08-24 |
| 1992317143 | Justin S Dole | Dentist | 15125 N Scottsdale Rd Apt 303, Scottsdale, AZ 85254-3157 | 2020-08-19 |
| 1326659087 | Triple Eight Dental Group, Pllc | Dentist | 7910 W Thomas Rd Ste 118, Phoenix, AZ 85033-4830 | 2020-08-14 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU |
| Zip Code | 86403 |
Please comment or provide details below to improve the information on ARIZONA HAVASU BDM PAK LLC.
| 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.