Individual provider Active NPI

Paulette Louise O'Connor, DDS

  • Dentist
  • Vista, CA
National Provider Identifier
1093182768
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
64976 Issued in CA
Practice address
1631 S Melrose Dr Ste I
Vista, CA 92081-2405
Phone
(760) 598-7565
Fax
(760) 598-6034
NPI assigned
Aug 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 64976 CA Primary

Addresses

Primary practice location

1631 S Melrose Dr Ste I
Vista, CA 92081-2405

Mailing address

1611 S Melrose Dr
Suite a #257
Vista, CA 92081-2405
Phone (760) 598-7565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
64976CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Reyes Garcia & O'Connor Dental, Inc. CurrentSince Feb 9, 2020 Accepting new patients

Locations

1611 S Melrose Dr
Ste A
Vista, CA 92081
Phone (760) 230-3451

1631 S Melrose Dr
Ste I
Vista, CA 92081
Phone (760) 598-7565

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1440720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1093182768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S MELROSE DR",
            "address_2": "SUITE A #257",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920812405",
            "telephone_number": "760-598-7565",
            "fax_number": "760-598-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 S MELROSE DR STE I",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920812405",
            "telephone_number": "760-598-7565",
            "fax_number": "760-598-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "PAULETTE",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-28",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "64976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.