Glenn Chester Prezkop, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

39924 Issued in CA

Practice address

1414 S Miller St Ste B
Santa Maria, CA 93454-6962

Phone

(805) 352-0225

Fax

(805) 352-0227

NPI assigned

Jul 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063443018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 S MILLER ST STE B",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934546962",
            "telephone_number": "805-352-0225",
            "fax_number": "805-352-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 S MILLER ST STE B",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934546962",
            "telephone_number": "805-352-0225",
            "fax_number": "805-352-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREZKOP",
        "first_name": "GLENN",
        "middle_name": "CHESTER",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "39924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prasan Mohansinh Parmar DDS, Inc.
• Catalina Pratt
• Premier Surgery Center of Santa Maria LLC
• Premise Health of California Medical PC (La Clinica FreSalud)
• John Rader Prewett, O.D.
• Delane Owen Price, PA-C
• Ronald Jay Prober, PT
• Professional Sports Physiatrists, S.C.
• Mari Proksel, PA-C
• Jon W Propst, MD

• Dentist in Santa Maria, CA
• Providers in Santa Maria, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.