Organization Active NPI

Dentist Near Me Culver City

  • Dental Clinic/Center
  • Culver City, CA
National Provider Identifier
1124711007
Registry record updated May 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DENTIST NEAR ME CULVER CITY
Practice address
4310 Overland Ave
Culver City, CA 90230-4117
Phone
(310) 837-8087
NPI assigned
May 29, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2023

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

Authorized official

Name
Nicole Guirguis, DDS
Title
Ceo
Phone
(310) 837-8087

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

4310 Overland Ave
Culver City, CA 90230-4117

Mailing address

4310 Overland Ave
Culver City, CA 90230-4117
Phone (310) 837-8087

Other identifiers 1

IdentifierTypeStateIssuer
1083135933MedicaidCA

National Provider Directory

National Provider Directory

Locations

4310 Overland Ave
Culver City, CA 90230
Phone (310) 837-8087

Practitioners & affiliated clinicians

Practitioners 1

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": "1685318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1124711007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 OVERLAND AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304117",
            "telephone_number": "310-837-8087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 OVERLAND AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304117",
            "telephone_number": "310-837-8087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTIST NEAR ME CULVER CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-29",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-28",
        "status": "A",
        "authorized_official_last_name": "GUIRGUIS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-837-8087",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083135933",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2023; 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.