Ota Dental Corp

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

57849 Issued in CA

Legal business name

OTA DENTAL CORP

Practice address

11834 Bryant St
#103
Yucaipa, CA 92399-3815

Phone

(909) 797-8090

NPI assigned

Feb 5, 2013

Organization subpart

No

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

Authorized official

Name

Lora C Ota, DDS

Title

Owner

Phone

(909) 797-8090

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marvin Eiji Ota, D.D.S.

  • General Practice Dentistry
  • Yucaipa, CA
  • NPI 1871675165
  NPD (past)

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

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360022400000",
    "number": "1043559453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11834 BRYANT ST",
            "address_2": "#103",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923993815",
            "telephone_number": "909-797-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11834 BRYANT ST",
            "address_2": "#103",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923993815",
            "telephone_number": "909-797-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTA DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-05",
        "last_updated": "2013-02-05",
        "status": "A",
        "authorized_official_last_name": "OTA",
        "authorized_official_first_name": "LORA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-797-8090",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "57849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "57849",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Optimum Physical Therapy & Wellness
• Chien Originales, PHARMD
• Emily Ortiz
• Richard Ortiz
• Alyson Ostdiek
• Marvin Eiji Ota, D.D.S.
• Macdaly Owens, FNP, RN
• Sooh Park
• Amanda Elise Parker
• Dwight Andrew Parker, PT

• Health Maintenance Organization in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; 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.