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 NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1114462330, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 60 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 3 providers are registered at the same or a nearby location.
SURPRISE, AZ 85374
SURPRISE, AZ 85374
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114462330, enumerated 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.
Clinic/Center with taxonomy code 261QD0000X and 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 verify.
