NPIMap

Organization Active NPI

Procare Dental Group, Joey S. Tirador D.D.S. Inc.

  • General Practice Dentistry
  • Victorville, CA
National Provider Identifier
1023253127
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
CA 50993 Issued in CA
Legal business name
PROCARE DENTAL GROUP, JOEY S. TIRADOR D.D.S. INC.
Practice address
12602 Amargosa Rd
Suite 'D'
Victorville, CA 92392-7640
Phone
(760) 951-9997
Fax
(760) 962-9424
NPI assigned
Dec 4, 2008
Organization subpart
Yes
Parent organization
1538343470As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Authorized official

Name
Dr. Joey Soriano Tirador, DDS
Title
President & Ceo
Phone
(760) 256-1189

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X CA 50993 CA Primary

Addresses

Primary practice location

12602 Amargosa Rd
Suite 'D'
Victorville, CA 92392-7640

Mailing address

12602 Amargosa Rd
Suite 'D'
Victorville, CA 92392-7640
Phone (760) 951-9997

Other identifiers 1

IdentifierTypeStateIssuer
G-94083-02OtherCAMEDI-CAL

National Provider Directory

National Provider Directory
Tax ID family
Procare Dental5 organizations share this tax ID, including this one
Part of
Procare Dental

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630627200000",
    "number": "1023253127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12602 AMARGOSA RD",
            "address_2": "SUITE 'D'",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923927640",
            "telephone_number": "760-951-9997",
            "fax_number": "760-962-9424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12602 AMARGOSA RD",
            "address_2": "SUITE 'D'",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923927640",
            "telephone_number": "760-951-9997",
            "fax_number": "760-962-9424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE DENTAL GROUP, JOEY S. TIRADOR D.D.S. INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1538343470",
        "enumeration_date": "2008-12-04",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "TIRADOR",
        "authorized_official_first_name": "JOEY",
        "authorized_official_middle_name": "SORIANO",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "760-256-1189",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "CA 50993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "G-94083-02",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; 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.