NPIMap

Organization Active NPI

Pacific Smile Dental Clinic

  • Dentist
  • Moreno Valley, CA
National Provider Identifier
1073987707
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
47031 Issued in CA
Legal business name
PACIFIC SMILE DENTAL CLINIC
Practice address
25025 Red Maple LN Ste 105
Moreno Valley, CA 92551-1137
Phone
(951) 924-6370
Fax
(951) 924-6374
NPI assigned
Nov 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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

Authorized official

Name
Maritza Mondragon
Title
Front Office
Phone
(951) 924-6370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 47031 CA Primary

Addresses

Primary practice location

25025 Red Maple LN Ste 105
Moreno Valley, CA 92551-1137

Mailing address

25025 Red Maple LN Ste 105
Moreno Valley, CA 92551-1137
Phone (951) 924-6370

National Provider Directory

National Provider Directory
Tax ID family
Pacific Smile Dental Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

25025 Red Maple Ln
Ste 105
Moreno Valley, CA 92551
Phone (951) 924-6370

Practitioners & affiliated clinicians

Practitioners 2

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": "1447804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447804800000",
    "number": "1073987707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25025 RED MAPLE LN STE 105",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925511137",
            "telephone_number": "951-924-6370",
            "fax_number": "951-924-6374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25025 RED MAPLE LN STE 105",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925511137",
            "telephone_number": "951-924-6370",
            "fax_number": "951-924-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SMILE DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-18",
        "last_updated": "2015-11-18",
        "status": "A",
        "authorized_official_last_name": "MONDRAGON",
        "authorized_official_first_name": "MARITZA",
        "authorized_official_title_or_position": "FRONT OFFICE",
        "authorized_official_telephone_number": "951-924-6370"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "47031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.