SURPRISE PEDIATRIC DENTISTRY, PC
NPI 1114462330
Clinic/Center - Dental in Surprise, AZ
NPI Status: Active since December 23, 2016
Contact Information
15331 W BELL RD
SUITE #112
SURPRISE, AZ
ZIP 85374
Phone: (602) 730-6481
Fax: (602) 730-6482
- Organization
- Clinic/Center
- Dental
- Accepts Insurance
- CLIA Number: 03D2003118
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-01-2026
About SURPRISE PEDIATRIC DENTISTRY, PC
This page provides the complete NPI Profile along with additional information for Surprise Pediatric Dentistry, Pc, a provider established in Surprise, Arizona operating as a Clinic/center, focusing in dental . The healthcare provider is registered in the NPI registry with number 1114462330 assigned on December 2016. The practitioner's primary taxonomy code is 261QD0000X with license number D008930 (AZ). The provider is registered as an organization and their NPI record was last updated 9 years ago. The authorized official of this NPI record is Dr. Mathew O Jensen Dmd (Dentist/owner)
- NPI
- 1114462330
- Provider Name
- SURPRISE PEDIATRIC DENTISTRY, PC
- Entity Type
- Organization
- Location Address
- 15331 W BELL RD SUITE #112 SURPRISE, AZ 85374
- Location Phone
- (602) 730-6481
- Location Fax
- (602) 730-6482
- Mailing Address
- 15331 W BELL RD SUITE #112 SURPRISE, AZ 85374
- Mailing Phone
- (602) 730-6481
- Mailing Fax
- (602) 730-6482
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-23-2016
- Last Update Date
- 12-23-2016
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Dental
- Taxonomy Code
- 261QD0000X
- Type
- Ambulatory Health Care Facilities
- License No.
- D008930
- License State
- AZ
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- DentaQuest PPO Pediatric High - PPO
- DentaQuest PPO Family High - PPO
- DentaQuest PPO Family Low - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 200173 | MEDICAID (05) | AZ |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 03D2003118
- Facility Type
- Physician Office
- Certificate Effective Date
- February 02, 2024
- Certificate Expiration Date
- February 01, 2026
- Laboratory Director
- STEVEN C. HORROCKS
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Surprise Pediatric Dentistry, Pc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 1 | 4 | 4 | 6 | 2 | 3 | 3 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 2 | 4 | 8 | 6 | 4 | 3 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 2 + 4 + 8 + 6 + 4 + 3 + 6 + 24 = 60 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1114462330 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1699968834 | MS. MOLLY FAITH COOK LCSW, LISAC Individual | Social Worker | 15331 W BELL RD STE 219 SURPRISE, AZ 85374 (928) 231-9635 |
| 1902348162 | TURNING POINT COUNSELING & RECOVERY TREATMENT CENTER Organization | Substance Abuse Rehabilitation Facility | 15331 W BELL RD SUITE 212-19 SURPRISE, AZ 85374 (623) 688-1279 |
| 1649084567 | BATTLE BELLES COMMUNITY BEHAVIORAL HEALTH SERVICES Organization | Clinic/Center (Mental Health (Including Community Mental Health Center)) | 15331 W BELL RD SURPRISE, AZ 85374 (630) 709-6896 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114462330, enumerated in the NPI registry as an "organization" on December 23, 2016
The provider is located at 15331 W Bell Rd Suite #112 Surprise, Az 85374 and the phone number is (602) 730-6481
This medical organization specializes in Clinic/Center with taxonomy code 261QD0000X with a focus in Dental
The provider might be accepting Accepts: DentaQuest Insurance Company, Inc., Medicare and. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 03D2003118 for a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..
This NPI record was last updated on December 23, 2016. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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