IDENTITY DENTAL SPECIALTIES – NPI #1275484495
Clinic/Center

IDENTITY DENTAL SPECIALTIES is an AHC clinic located in PHOENIX, AZ. NPPES has assigned the NPI number 1275484495 to IDENTITY DENTAL SPECIALTIES on February 04, 2026. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for IDENTITY DENTAL SPECIALTIES below.

NPI Profile for
IDENTITY DENTAL SPECIALTIES

NPI Number
1275484495
Enumeration Date

(about 4 months ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
IDENTITY DENTAL SPECIALTIES
Primary location
18325 N ALLIED WAY STE 115
PHOENIX, AZ 85054-3107
Phone: (480) 661-4867 Fax: (480) 661-1266
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
MARIYANA PAVLOVA
CEO, PRESIDENT
Phone: (480) 661-4867
Updated
Certification Date
Feb 04, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.