NPIMap

Organization Active NPI

Escondido Pediatric Dentistry, a Dental Office of Dr. Christian M Fort

  • Pediatric Dentistry
  • Escondido, CA
National Provider Identifier
1093372351
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ESCONDIDO PEDIATRIC DENTISTRY, A DENTAL OFFICE OF DR. CHRISTIAN M FORT
Practice address
925 E Pennsylvania Ave Ste I
Escondido, CA 92025-3432
Phone
(760) 743-7176
NPI assigned
May 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Authorized official

Name
Dr. Christian M Fortney Ciccarella, DDS
Title
President
Phone
(760) 317-9598

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

925 E Pennsylvania Ave Ste I
Escondido, CA 92025-3432

Mailing address

925 E Pennsylvania Ave Ste I
Escondido, CA 92025-3432
Phone (760) 743-7176

Other names 1

  • Escondido Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558483200000",
    "number": "1093372351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 E PENNSYLVANIA AVE STE I",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253432",
            "telephone_number": "760-743-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 E PENNSYLVANIA AVE STE I",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253432",
            "telephone_number": "760-743-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESCONDIDO PEDIATRIC DENTISTRY, A DENTAL OFFICE OF DR. CHRISTIAN M FORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-05-22",
        "status": "A",
        "authorized_official_last_name": "FORTNEY CICCARELLA",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-317-9598",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Escondido Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Escondido, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.

Verify at the official NPI Registry.