NPIMap

Organization Active NPI

David a Neal, DDS a Professional Corporation

  • Dental Clinic/Center
  • Lodi, CA
National Provider Identifier
1073265146
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DAVID A NEAL, DDS A PROFESSIONAL CORPORATION
Practice address
1104 S Fairmont Ave
Lodi, CA 95240-5542
Phone
(209) 369-3657
NPI assigned
Jan 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Shana Ackerman, RDH
Title
Manager
Phone
(209) 369-3657

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1104 S Fairmont Ave
Lodi, CA 95240-5542

Mailing address

1104 S Fairmont Ave
Lodi, CA 95240-5542
Phone (209) 369-3657

Other names 1

  • The Lodi Dentist Doing business as

National Provider Directory

National Provider Directory

Locations

1104 S Fairmont Ave
Lodi, CA 95240
Phone (209) 369-3657

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1073265146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405542",
            "telephone_number": "209-369-3657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405542",
            "telephone_number": "209-369-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID A NEAL, DDS A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "ACKERMAN",
        "authorized_official_first_name": "SHANA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "209-369-3657",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lodi Dentist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.