Sergio Vicuna Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SERGIO VICUNA DENTAL CORPORATION

Practice address

4515 Fermi Place Suite 106
Davis, CA 95618

Phone

(310) 451-5060

Fax

(310) 451-5062

NPI assigned

Nov 12, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Sergio Vicuna, DDS

Title

Owner Doctor

Phone

(310) 451-5060

Specialties & licenses 1

Addresses

Other names 1

• Davis Smiles Dentistry Dental Group Doing business as

Locations

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384214400000",
    "number": "1063841096",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "17000 RED HILL AVENUE",
            "city": "IRVINE",
            "state": "ORANGE",
            "postal_code": "92614",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 FERMI PLACE SUITE 106",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "95618",
            "telephone_number": "310-451-5060",
            "fax_number": "310-451-5062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERGIO VICUNA DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2013-11-12",
        "status": "A",
        "authorized_official_last_name": "VICUNA",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "310-451-5060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Smiles Dentistry Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anne Elizabeth Seiler, CNM
• Kassondra Seney
• Ashley Sens, M.D.
• Nan Senzaki, LCSW
• Serenity Now Behavioral Health LLC
• Sharon C Sevilla-Bodine, MD
• Mansoor Shafqat, ABOC, NCLEC, LDO
• Bita J. Shaghaghi, D.O.
• Iffat Shah, COTA
• G. Duane Shaul

• Dentist in Davis, CA
• Providers in Davis, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.