Provider Demographics
NPI:1295190643
Name:MARIPOSA DENTAL GROUP, PLC
Entity Type:Organization
Organization Name:MARIPOSA DENTAL GROUP, PLC
Other - Org Name:SMILE ARIZONA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER SCHAAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-994-5225
Mailing Address - Street 1:7327 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7215
Mailing Address - Country:US
Mailing Address - Phone:809-994-5225
Mailing Address - Fax:480-462-1898
Practice Address - Street 1:7327 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7215
Practice Address - Country:US
Practice Address - Phone:809-994-5225
Practice Address - Fax:480-462-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD044261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000826545OtherUNITED CONCORDIA
AZ149775Medicaid
1033258496OtherNPI