EAST VALLEY IMPLANT & PERIODONTAL CENTER (NPI# 1376019075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376019075 |
| Entity Type | Organization |
| Organization Name | EAST VALLEY IMPLANT & PERIODONTAL CENTER |
| Practice Address |
3048 E Baseline Rd Ste 112 Mesa AZ 85204-7287 |
| Practice Telephone | 4805584504 |
| Practice Fax Number | 4808279703 |
| Mailing Telephone | 4805584504 |
| Mailing Fax Number | 4808279703 |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2018-10-19 |
| Authorized Official Name | MRS. BRETT E LEE (OFFICE MANAGER) |
| Authorized Official Telephone | 4805584504 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
3048 E BASELINE RD STE 112 |
| City | MESA |
| State | AZ |
| Zip Code | 85204-7287 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457900656 | East Valley Implant and Periodontal Pllc | Dentist | 3048 E Baseline Rd Ste 112, Mesa, AZ 85204-7287 | 2019-09-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194374819 | Luminations Healing Center, LLC | Social Worker | 1237 S. Val Vista Dr. #221, Mesa, AZ 85204 | 2019-09-05 |
| 1881160356 | Wanjiru Landers | Student in an Organized Health Care Education/Training Program | 550 S Linda Circle, Mesa, AZ 85204 | 2018-10-22 |
| 1649754235 | Adam Desnous | Specialist/Technologist | 751 S Daley, Mesa, AZ 85204 | 2018-09-19 |
| 1982128187 | Michael Anthony Jones | Counselor | 1107 North Gilbert Rd, Mesa, AZ 85204 | 2017-07-29 |
| 1295287225 | Scottsdale Healthcare Corp | Family Medicine | 2530 W. Southern Ave, Mesa, AZ 85204 | 2016-10-25 |
| 1427504158 | Richard White | Physician Assistant | 2345 E Southern Ave # 101, Mesa, AZ 85204 | 2016-09-01 |
| 1548716780 | Pain Stop Accident Injury LLC | Chiropractor | 425 E 11th Ave, Mesa, AZ 85204 | 2016-08-28 |
| 1154704252 | Glenn Taylor Lesueur | Dentist | 1056 S. Val Vista Dr., Suite 1, Mesa, AZ 85204 | 2015-07-07 |
| 1073932513 | Naomi Devine | Nurse Practitioner | 1840 South Stapley Drive, Suite 101, Mesa, AZ 85204 | 2014-04-14 |
| 1609292531 | John Kamau | Counselor | 1060 S Lobin Ln, Mesa, AZ 85204 | 2014-03-17 |
| Find all providers in zip 85204 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518232701 | Niels Jensen | Dentist | 6755 E Superstition Springs Blvd Ste 102, Mesa, AZ 85206-4375 | 2012-03-20 |
| 1609166644 | Nicholas D Allan | Dentist | 2831 E Southern Ave, #215, Mesa, AZ 85204-5500 | 2011-04-11 |
| 1891795282 | Paul Wadley Haycock | Dentist | 6755 E Superstition Springs Blvd, Suite 102, Mesa, AZ 85206-4373 | 2005-07-28 |
| 1457900656 | East Valley Implant and Periodontal Pllc | Dentist | 3048 E Baseline Rd Ste 112, Mesa, AZ 85204-7287 | 2019-09-10 |
| 1568980001 | Aaron Clark Nelson | Dentist | 6755 E Superstition Springs Blvd Ste 102, Mesa, AZ 85206-4375 | 2017-09-05 |
| 1811288384 | Satish S. Kumar | Dentist | 5855 E Still Cir, Mesa, AZ 85206 | 2011-05-02 |
| 1871805291 | Joseph Wayne Capps | Dentist | 4996 S Power Rd, Mesa, AZ 85212-3602 | 2010-07-14 |
| 1063649192 | East Valley Periodontics | Dentist | 6755 E Superstition Springs Blvd, Ste. 102, Mesa, AZ 85206-4373 | 2009-06-16 |
| 1629223367 | Christine Ann Halket | Dentist | 5855 E Still Cir, Mesa, AZ 85206-3631 | 2008-11-21 |
| 1821242082 | Morley J. Smith, Dmd, PC | Dentist | 6755 E Superstition Springs Blvd, Suite 102, Mesa, AZ 85206-4373 | 2008-11-13 |
| 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.