Active NPI
Mark Francis Enverga, DDS
- General Practice Dentistry
- Ontario, CA
National Provider Identifier
1093293672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 103004
- Practice address
- 2508 S Grove Ave
Ontario, CA 91761-6253 - Phone
- (909) 635-5483
- NPI assigned
- Aug 5, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 103004 | CA | Primary |
Addresses
Primary practice location
2508 S Grove Ave
Ontario, CA 91761-6253
Mailing address
2508 S Grove Ave
Ontario, CA 91761-6253
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103004 | Other | CA | DENTAL BOARD OF CALIFORNIA |
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 |
|---|---|---|---|
| 103004 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533427200000",
"number": "1093293672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2508 S GROVE AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917616253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2508 S GROVE AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917616253",
"telephone_number": "909-635-5483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENVERGA",
"first_name": "MARK FRANCIS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-05",
"last_updated": "2018-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "103004",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL BOARD OF CALIFORNIA",
"identifier": "103004",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.