Active NPI
Bernard Lagelle Jeter Sr., D.D.S.
- General Practice Dentistry
- Visalia, CA
National Provider Identifier
1003951864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 23523
- Practice address
- 805 W. Acequia Ave
#2B
Visalia, CA 93291 - Phone
- (559) 739-8400
- Fax
- (559) 739-8333
- NPI assigned
- Feb 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13691 | CA | |
| General Practice Dentistry | 1223G0001X | 23523 | CA | Primary |
Addresses
Primary practice location
805 W. Acequia Ave
#2B
Visalia, CA 93291
Mailing address
805 W. Acequia Ave
#2B
Visalia, CA 93291
Phone (559) 739-8400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B 23523 01 | Other | CA | DENTICAL |
| 862543 | Other | CA | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13691 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason Jeter & Lagelle Jeter DDS, Inc. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Visalia, CA
- NPI 1699069377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254787200000",
"number": "1003951864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 W. ACEQUIA AVE",
"address_2": "#2B",
"city": "VISALIA",
"state": "CA",
"postal_code": "93291",
"telephone_number": "559-739-8400",
"fax_number": "559-739-8333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 W. ACEQUIA AVE",
"address_2": "#2B",
"city": "VISALIA",
"state": "CA",
"postal_code": "93291",
"telephone_number": "559-739-8400",
"fax_number": "559-739-8333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JETER",
"first_name": "BERNARD",
"middle_name": "LAGELLE",
"name_suffix": "Sr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-20",
"last_updated": "2009-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "13691",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "23523",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTICAL",
"identifier": "B 23523 01",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "862543",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Visalia, CA
- Christine Marie Jensen, LCSW
- Jerry L Lanier DDS Inc (Star Tek Adult Dental Group)
- Jerry L Lanier DDS, Inc (Kids 2 Dentist Dental Group)
- Jerry Yasuda,O.D. Inc.
- Kristi D. Jessee, M.A., CCC-SLP
- Jason L Jeter, DDS
- Mary Colette Jewell, OT
- Nitya Neerav Jhaveri
- Ji Hyun Kim Dental Corp. (Ben Maddox Family Dental)
- Yan Jiang, FNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.