Joe Allan Provines, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

20440 Issued in CA

Practice address

105 South Dr
Suite 200
Mountain View, CA 94040-4311

Phone

(650) 964-4867

Fax

(650) 964-4864

NPI assigned

Oct 13, 2006

Last updated

Apr 4, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459728000000",
    "number": "1124118914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 W FREMONT AVE",
            "address_2": "STE I2",
            "city": "SUNNYVALE",
            "state": "CA",
            "postal_code": "940872319",
            "telephone_number": "650-964-4867",
            "fax_number": "650-964-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SOUTH DR",
            "address_2": "SUITE 200",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404311",
            "telephone_number": "650-964-4867",
            "fax_number": "650-964-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVINES",
        "first_name": "JOE",
        "middle_name": "ALLAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2016-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "20440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Mountain View, CA
• Providers in Mountain View, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.