NPIMap

Organization Active NPI

Santa Rosa Dental

  • General Practice Dentistry
  • Santa Rosa, CA
National Provider Identifier
1043309727
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30068 Issued in CA
Legal business name
SANTA ROSA DENTAL
Practice address
2360 Mendocino Ave
Suite a 6
Santa Rosa, CA 95403-3153
Phone
(707) 568-1436
Fax
(707) 568-1483
NPI assigned
Oct 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Myrna Menjivar Gray, DDSNPI 1194812156
Title
Partner
Phone
(415) 299-9566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30433 CA
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30461 CA
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30068 CA Primary

Addresses

Primary practice location

2360 Mendocino Ave
Suite a 6
Santa Rosa, CA 95403-3153

Mailing address

188 Stanford Ave
Mill Valley, CA 94941-3546
Phone (415) 389-9566

Other names 1

  • Dinu A Gray, DDS/Myrna Menjivar Gray,DDS/Eugene Field,DDS Doing business as

National Provider Directory

National Provider Directory

Locations

2360 Mendocino Ave
Ste A6
Santa Rosa, CA 95403
Phone (707) 568-1436

Practitioners & affiliated clinicians

Practitioners 3

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": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043309727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 STANFORD AVE",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413546",
            "telephone_number": "415-389-9566",
            "fax_number": "415-389-9563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 MENDOCINO AVE",
            "address_2": "SUITE A 6",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033153",
            "telephone_number": "707-568-1436",
            "fax_number": "707-568-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MENJIVAR GRAY",
        "authorized_official_first_name": "MYRNA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "415-299-9566",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30433",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30461",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dinu A Gray, DDS/Myrna Menjivar Gray,DDS/Eugene Field,DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.