Individual provider Active NPI

Robert Dennis Whitley, D.D.S.

  • General Practice Dentistry
  • Tarzana, CA
National Provider Identifier
1023112265
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
34258 Issued in CA
Practice address
19588 Ventura Blvd
Tarzana, CA 91356-2917
Phone
(818) 345-4383
Fax
(818) 705-2513
NPI assigned
Sep 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 34258 CA Primary

Addresses

Primary practice location

19588 Ventura Blvd
Tarzana, CA 91356-2917

Mailing address

19588 Ventura Blvd
Tarzana, CA 91356-2917
Phone (818) 345-4383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160404001625 CA Order and Referring Only - Other (Non-Physician) 2163729278

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34258CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Sooferi & Sooferian Dental Practice Inc General Practice PastSince Dec 3, 2023 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.

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023112265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19588 VENTURA BLVD",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913562917",
            "telephone_number": "818-345-4383",
            "fax_number": "818-705-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19588 VENTURA BLVD",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913562917",
            "telephone_number": "818-345-4383",
            "fax_number": "818-705-2513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITLEY",
        "first_name": "ROBERT",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "34258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarzana, CA

Sources for this page

Verify at the official NPI Registry.