NPIMap

Organization Active NPI

A. Dominguez DDS Professional Dental Corporation

  • General Practice Dentistry
  • Chula Vista, CA
National Provider Identifier
1013373620
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
50595 Issued in CA
Legal business name
A. DOMINGUEZ DDS PROFESSIONAL DENTAL CORPORATION
Practice address
290 Landis Ave
Ste a&B
Chula Vista, CA 91910-2636
Phone
(619) 691-0121
NPI assigned
Jan 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Reid
Title
Business Manager
Phone
(619) 691-0121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 50595 CA Primary

Addresses

Primary practice location

290 Landis Ave
Ste a&B
Chula Vista, CA 91910-2636

Mailing address

290 Landis Ave
Ste a&B
Chula Vista, CA 91910-2636
Phone (619) 691-0121

Other names 1

  • AD Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1013373620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 LANDIS AVE",
            "address_2": "STE A&B",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102636",
            "telephone_number": "619-691-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 LANDIS AVE",
            "address_2": "STE A&B",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102636",
            "telephone_number": "619-691-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A. DOMINGUEZ DDS PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-12",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "619-691-0121"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AD Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.