Active NPI
Lauryn Elizabeth Gresham
- Dental Assistant
- Fresno, CA
National Provider Identifier
1093289902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 91009
- Practice address
- 6323 N Fresno St Ste 101
Fresno, CA 93710-5282 - Phone
- (559) 439-2307
- NPI assigned
- Jan 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 91009 | CA | Primary |
Addresses
Primary practice location
6323 N Fresno St Ste 101
Fresno, CA 93710-5282
Mailing address
34697 Road 221 Wishon Ca 93669
P.O. Box 852
North Fork Ca, CALIFORNIA 93643
UM
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D8733126 | Other | CA | NON MEDICARE |
| D8733126 | Other | CA | SELF |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 91009 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547424000000",
"number": "1093289902",
"addresses": [
{
"country_code": "UM",
"country_name": "United States Minor Outlying Islands",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "34697 ROAD 221 WISHON CA 93669",
"address_2": "P.O. BOX 852",
"city": "NORTH FORK CA",
"state": "CALIFORNIA",
"postal_code": "93643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6323 N FRESNO ST STE 101",
"city": "FRESNO",
"state": "CA",
"postal_code": "937105282",
"telephone_number": "559-439-2307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRESHAM",
"first_name": "LAURYN",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-14",
"last_updated": "2019-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "91009",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NON MEDICARE",
"identifier": "D8733126",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SELF",
"identifier": "D8733126",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.