Individual provider Active NPI

Wendy Christina Gregorius, DDS

  • Prosthodontics
  • Loma Linda, CA
National Provider Identifier
1063664621
Registry record updated Oct 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
57746 Issued in CA
Practice address
11092 Anderson Street
Llu School of Dentistry
Loma Linda, CA 92350-0001
Phone
(909) 558-4613
Fax
(909) 558-4192
NPI assigned
Oct 15, 2008
Last updated
Oct 15, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 57746 CA Primary

Addresses

Primary practice location

11092 Anderson Street
Llu School of Dentistry
Loma Linda, CA 92350-0001

Mailing address

11092 Anderson Street
Llu School of Dentistry
Loma Linda, CA 92350-0001
Phone (909) 558-4613

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230718003028 CA Order and Referring Only - DentistPractitioner - Dentist 0648630921

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224028800000",
    "number": "1063664621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11092 ANDERSON STREET",
            "address_2": "LLU SCHOOL OF DENTISTRY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923500001",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11092 ANDERSON STREET",
            "address_2": "LLU SCHOOL OF DENTISTRY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923500001",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREGORIUS",
        "first_name": "WENDY",
        "middle_name": "CHRISTINA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-15",
        "last_updated": "2008-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "57746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.