Visalia Children's Dental Surgery Center Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

23135 Issued in CA

Legal business name

VISALIA CHILDREN'S DENTAL SURGERY CENTER INC

Practice address

136 Aspen Court
Suite a
Visalia, CA 93291

Phone

(559) 625-9300

Fax

(559) 625-9330

NPI assigned

Feb 5, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Devin Larsen

Title

Ceo

Phone

(208) 340-1840

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053643783. Details of each certification follow.

• CCN 05C0001938 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 05C0001938

Legal name

Visalia Children's Dental Surgery Center, Inc

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Dec 22, 2010

Last certification

Aug 20, 2019

Ownership / control type

Proprietary

Facility address

136 Aspen Court, Suite a
Visalia, CA 93291

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellie Jeanette Zuiderveld, DDS

  • Dentist
  • Visalia, CA
  • NPI 1083631709
  NPD

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

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1053643783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 LAKESIDE BLVD STE 350",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773811213",
            "telephone_number": "713-489-2198",
            "fax_number": "713-489-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 ASPEN COURT",
            "address_2": "SUITE A",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "93291",
            "telephone_number": "559-625-9300",
            "fax_number": "559-625-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISALIA CHILDREN'S DENTAL SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-05",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-340-1840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "23135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Visalia Adult Day Health Care Facility, Inc.
• Visalia Ambulatory Surgical Center LLC
• Visalia Cardiovascular and Medical Center, Inc
• Visalia Cardiovascular and Medical Center, Inc
• Visalia Center for Ambulatory Medicine and Surgery
• Visalia Dentistry 4 Kids
• Visalia Eye Center, Inc. (Visalia Eye Center)
• Visalia Eye Center, Inc. (Visalia Eye Center)
• Visalia Faculty Medical Group Inc.
• Visalia Family Eye Care Optometry PC

• Ambulatory Surgical Clinic/Center in Visalia, CA
• Providers in Visalia, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.