NPIMap

Organization Active NPI

Loma Linda Univeristy

  • Periodontics
  • Loma Linda, CA
National Provider Identifier
1124185194
Registry record updated Mar 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
2043 Issued in CA
Legal business name
LOMA LINDA UNIVERISTY
Practice address
Loma Linda University--School of Dentistry
11092 Anderson Street
Loma Linda, CA 92354
Phone
(909) 558-4613
Fax
(909) 558-4192
NPI assigned
Jan 2, 2007
Last updated
Mar 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2020

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

Authorized official

Name
Mr. Rodney Dale Neal
Title
Vice President
Phone
(909) 558-4543

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 2043 CA Primary

Addresses

Primary practice location

Loma Linda University--School of Dentistry
11092 Anderson Street
Loma Linda, CA 92354

Mailing address

Loma Linda University--School of Dentistry
11092 Anderson Street
Loma Linda, CA 92354
Phone (909) 558-4613

Other identifiers 1

IdentifierTypeStateIssuer
G02000-01MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Loma Linda University School of Dentistry20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1124185194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "LOMA LINDA UNIVERSITY--SCHOOL OF DENTISTRY",
            "address_2": "11092 ANDERSON STREET",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LOMA LINDA UNIVERSITY--SCHOOL OF DENTISTRY",
            "address_2": "11092 ANDERSON STREET",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOMA LINDA UNIVERISTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "909-558-4543",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "2043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G02000-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.