Individual provider Active NPI

Edward Lee Vera, D.M.D.

  • Dentist
  • Fontana, CA
National Provider Identifier
1033468368
Registry record updated May 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
29646 Issued in TX
Practice address
16946 Marygold Ave Ste 101
Fontana, CA 92335-1724
Phone
(909) 355-0385
NPI assigned
Aug 31, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61531 CA
Dentist 122300000X 29646 TX Primary

Addresses

Primary practice location

16946 Marygold Ave Ste 101
Fontana, CA 92335-1724

Mailing address

10670 N Loop Dr
Socorro, TX 79927-4613
Phone (915) 444-2567

Other practice location 1

10670 N Loop Dr
Socorro, TX 79927-4613
Phone (915) 444-2567

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

LicenseStateTypeSpecialty
29646TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
FV Denta PLLC Dentist CurrentSince Jun 7, 2020 Accepting new patients
FV Dental, PLLC CurrentSince Nov 5, 2023 Accepting new patients
Mohammad Abul Fielat DDS Inc PastSince May 31, 2020 Accepting new patients

Locations

10670 N Loop Dr
Socorro, TX 79927
Phone (915) 444-2567

Organizations & group practices 3

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": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1033468368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10670 N LOOP DR",
            "city": "SOCORRO",
            "state": "TX",
            "postal_code": "799274613",
            "telephone_number": "915-444-2567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16946 MARYGOLD AVE STE 101",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923351724",
            "telephone_number": "909-355-0385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10670 N Loop Dr",
            "address_purpose": "LOCATION",
            "city": "Socorro",
            "state": "TX",
            "postal_code": "799274613",
            "country_code": "US",
            "telephone_number": "915-444-2567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERA",
        "first_name": "EDWARD",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-31",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61531",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "29646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; 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.