AGE DEFYING DENTISTRY (NPI# 1962721001) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962721001 |
| Entity Type | Organization |
| Organization Name | AGE DEFYING DENTISTRY |
| Practice Address |
21321 East Ocotillo Rd Bldg M, Ste 130 Queen Creek AZ 85142 |
| Practice Telephone | 4808409200 |
| Mailing Telephone | 4808409200 |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2010-05-28 |
| Authorized Official Name | DR. DAVID J VELASCO (MANAGER) |
| Authorized Official Telephone | 4808409200 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | AZ4044 | AZ | Dental Providers |
| Street Address |
21321 EAST OCOTILLO RD BLDG M, STE 130 |
| City | QUEEN CREEK |
| State | AZ |
| Zip Code | 85142 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093346033 | Arizona Dental Professionals, P.C. | Dentist | 20311 S Ellsworth Rd Ste 101, Queen Creek, AZ 85142 | 2020-01-29 |
| 1073158903 | Jonathan Corey Barber | Physical Therapy Assistant | 22424 South Ellsworth Loop Road, #464, Queen Creek, AZ 85142 | 2019-11-14 |
| 1689142333 | Erin Sohr | Occupational Therapy Assistant | 4594 W Federal Way, San Tan Valley, AZ 85142 | 2018-11-10 |
| 1083180723 | Katelyn Hannabach | Physician Assistant | 21323 S Ellsworth Loop Rd Ste 101, Queen Creek, AZ 85142 | 2018-10-20 |
| 1043701899 | Brittany Leigh Amor | Dentist | 18550 E Rittenhouse Rd Ste 103, Queen Creek, AZ 85142 | 2018-05-28 |
| 1861925604 | Shani Thompson | Student in an Organized Health Care Education/Training Program | 22437 S 209th Way, Queen Creek, AZ 85142 | 2017-04-08 |
| 1689115164 | 360 Physical Therapy LLC | Physical Therapist | 21576 S Ellsworth Loop Rd, 150, Queen Creek, AZ 85142 | 2017-03-16 |
| 1891233714 | Candee J. Eisenhart | Nurse Practitioner | 21321 E Ocotillo Rd Ste 102, Queen Creek, AZ 85142 | 2017-02-11 |
| 1790231546 | Carrie Church | Nurse Practitioner | 20185 E Ocotillo Rd Ste 104, Queen Creek, AZ 85142 | 2016-08-31 |
| 1669836649 | Horizon Health and Wellness, Inc. | Community/Behavioral Health | 22713 S. Ellsworth Road, Building A, Queen Creek, AZ 85142 | 2016-04-06 |
| Find all providers in zip 85142 | ||||
| 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 |
|---|---|---|---|---|
| 1043701899 | Brittany Leigh Amor | Dentist | 18550 E Rittenhouse Rd Ste 103, Queen Creek, AZ 85142 | 2018-05-28 |
| 1114377751 | Charles W Culler | Dentist | 18610 E Rittenhouse Rd Ste A103, Queen Creek, AZ 85142-4504 | 2016-06-14 |
| 1003285834 | Spencer Torgerson | Dentist | 22717 S Ellsworth Rd # R, Suite B102, Queen Creek, AZ 85142-6127 | 2015-09-23 |
| 1295158947 | Douglas B Hunt PC | Dentist | 22711 S Ellsworth Rd, Queen Creek, AZ 85142-6788 | 2014-01-31 |
| 1689015398 | Mindi Alyse D'elia | Dentist | 1714 W Hunt Hwy, Ste 102, Queen Creek, AZ 85143-5244 | 2013-07-10 |
| 1972943793 | Jaime Jeanette Norton | Dentist | 18550 E Rittenhouse Rd, 103, Queen Creek, AZ 85142-4598 | 2013-06-25 |
| 1437598216 | Cody Cutler | Dentist | 23844 S Power Rd, Ste. B106, Queen Creek, AZ 85142-6152 | 2013-06-14 |
| 1275971988 | Mark A Johnson | Dentist | 1714 W Hunt Hwy Ste 100, Queen Creek, AZ 85143-5245 | 2013-06-05 |
| 1164770392 | Michael Edward Holub | Dentist | 21582 S Ellsworth Loop Rd Ste 126, Queen Creek, AZ 85142-7882 | 2012-08-20 |
| 1396025573 | Cameron Weaver Blyth | Dentist | 22211 South Elsworth Rd, Queen Creek, AZ 85142 | 2011-08-19 |
| Find all providers in QUEEN CREEK | ||||
| City | QUEEN CREEK |
| Zip Code | 85142 |
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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.