MAGIC SMILES DENTAL – NPI #1821369455
Clinic/Center

MAGIC SMILES DENTAL is an AHC clinic located in MESA, AZ. NPPES has assigned the NPI number 1821369455 to MAGIC SMILES DENTAL on January 12, 2012. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “MAGIC SMILES DENTAL” is a dba name, the actual legal business name for this organization is PDA HOLDCO, LLC. This provider is also associated with 2 additional names listed below. With multiple taxonomy codes selected, 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

The NPI profile was previously updated about 3 years ago on Feb 07, 2023. 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 MAGIC SMILES DENTAL below.

NPI Profile for
PDA HOLDCO, LLC

NPI Number
1821369455
Enumeration Date

(more than 14 years 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
PDA HOLDCO, LLC
Doing Business As (dba): MAGIC SMILES DENTAL
Other name(s)
All associated names:
Doing Business As (dba)
MAGIC SMILES DENTAL
Doing Business As (dba)
Magic Smiles Dental Care
Primary location
1457 W SOUTHERN AVE STE 18
MESA, AZ 85202-4853
Phone: (480) 610-2300 Fax: (480) 833-0682
Mailing address
1701 E THOMAS RD
SUITE #204
PHOENIX, AZ 85016-7646
Phone: (602) 253-6600 Fax: (602) 279-0821
Organization Subpart
Yes - MAGIC SMILES DENTAL is subpart of another organization.
Authorized Official
DANIEL MORRISSEY
PRESIDENT
Phone: (602) 253-6600
Updated
Certification Date
Feb 07, 2023

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.

Identifiers

Identifiers for MAGIC SMILES DENTAL

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidAZ670703
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)
122300000X
- Dentist		 AZ D5504

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.