MESA KIDTASTIC DENTAL LLC (NPI# 1942841663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942841663 |
| Entity Type | Organization |
| Organization Name | MESA KIDTASTIC DENTAL LLC |
| Practice Address |
1240 W Southern Ave Ste 112 Mesa AZ 85202-4882 |
| Practice Telephone | 4037335437 |
| Mailing Telephone | 4037335437 |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2019-10-03 |
| Authorized Official Name | FAITH GASKINS (DIRECTOR OF CREDENTIALING) |
| Authorized Official Telephone | 9728693789 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Street Address |
1240 W SOUTHERN AVE STE 112 |
| City | MESA |
| State | AZ |
| Zip Code | 85202-4882 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217303 | Kyle Franklin | Dentist | 1240 W Southern Ave Ste 112, Mesa, AZ 85202-4882 | 2020-08-25 |
| 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 |
| 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 |
| 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.