NPIMap

Organization Active NPI

Lucero Dental Clinic

  • General Practice Dentistry
  • Garden Grove, CA
National Provider Identifier
1104955475
Registry record updated Feb 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
35947 Issued in CA
Legal business name
LUCERO DENTAL CLINIC
Practice address
12833 Harbor Blvd
Suite F 3
Garden Grove, CA 92840-5806
Phone
(714) 534-9480
Fax
(714) 534-9482
NPI assigned
Mar 5, 2007
Last updated
Feb 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2012

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

Authorized official

Name
Dr. Martha R Lucero, DDSNPI 1861655417
Title
Owner and President
Phone
(714) 534-9480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 35947 CA Primary

Addresses

Primary practice location

12833 Harbor Blvd
Suite F 3
Garden Grove, CA 92840-5806

Mailing address

12833 Harbor Blvd
Suite F 3
Garden Grove, CA 92840-5806
Phone (714) 534-9480

National Provider Directory

National Provider Directory

Locations

12833 Harbor Blvd
Ste F
Garden Grove, CA 92840
Phone (714) 534-9480

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328659200000",
    "number": "1104955475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12833 HARBOR BLVD",
            "address_2": "SUITE F 3",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405806",
            "telephone_number": "714-534-9480",
            "fax_number": "714-534-9482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12833 HARBOR BLVD",
            "address_2": "SUITE F 3",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405806",
            "telephone_number": "714-534-9480",
            "fax_number": "714-534-9482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCERO DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2012-02-08",
        "status": "A",
        "authorized_official_last_name": "LUCERO",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER AND PRESIDENT",
        "authorized_official_telephone_number": "714-534-9480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "35947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2012; 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.