Active NPI
Sheri Widdis, CDA, RDA
- Dental Assistant
- Moorpark, CA
National Provider Identifier
1033565205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 42174
- Practice address
- 4711 Moorpark Ave
27
Moorpark, CA 93021-4125 - Phone
- (609) 846-6460
- NPI assigned
- May 6, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 42174 | CA | Primary |
Addresses
Primary practice location
4711 Moorpark Ave
27
Moorpark, CA 93021-4125
Mailing address
4711 Moorpark Ave
27
Moorpark, CA 93021-4125
Phone (609) 846-6460
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 |
|---|---|---|---|
| 42174 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462492800000",
"number": "1033565205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4711 MOORPARK AVE",
"address_2": "27",
"city": "MOORPARK",
"state": "CA",
"postal_code": "930214125",
"telephone_number": "609-846-6460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4711 MOORPARK AVE",
"address_2": "27",
"city": "MOORPARK",
"state": "CA",
"postal_code": "930214125",
"telephone_number": "609-846-6460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDDIS",
"first_name": "SHERI",
"credential": "CDA, RDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-06",
"last_updated": "2016-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "42174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moorpark, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.