Maryvale Children'S Dentistry And Orthodontics PLLC
Clinic/Center, Dental in Phoenix, AZ. Organization (NPI-2).
NPI number1245089952
StatusActive
Last updated in NPPESMay 15, 2024
Details
- NPI
- 1245089952
- Entity type
- Organization (NPI-2)
- Legal business name
- Maryvale Children'S Dentistry And Orthodontics PLLC
- Organization subpart
- No
- Enumeration date
- May 15, 2024
- Certification date
- May 15, 2024
- Last updated
- May 15, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Maryvale Children'S Dentistry (Doing Business As)
- Maryvale Children'S Dentistry And Orthodontics (Doing Business As)
Practice location
4700 N 51st Ave Ste 3Phoenix, AZ 85031-1237
Phone 480-432-3363
Mailing address
12945 S 176th LnGoodyear, AZ 85338-5786
Phone 480-432-3363
Authorized official
Jesse McGuire
Member
4804323363
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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