NPIMap

Organization Active NPI

Fred C. Stalley,D.D.S. Inc.

Doing business as Redondo Beach Dental Group

  • General Practice Dentistry
  • Redondo Beach, CA
National Provider Identifier
1144342908
Registry record updated Oct 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
28095 Issued in CA
Legal business name
FRED C. STALLEY,D.D.S. INC.
Doing business as
Redondo Beach Dental Group
Practice address
2511 Artesia Blvd
Redondo Beach, CA 90278-3209
Phone
(310) 542-6988
Fax
(310) 542-3182
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2008

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

Authorized official

Name
Dr. Fred C Stalley, D.D.S.NPI 1598887382
Title
Dentist
Phone
(310) 542-6988

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 28095 CA Primary

Addresses

Primary practice location

2511 Artesia Blvd
Redondo Beach, CA 90278-3209

Mailing address

2511 Artesia Blvd
Redondo Beach, CA 90278-3209
Phone (310) 542-6988

Other names 1

  • Redondo Beach Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

2511 Artesia Blvd
Redondo Beach, CA 90278
Phone (310) 542-6988

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": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1144342908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 ARTESIA BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783209",
            "telephone_number": "310-542-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 ARTESIA BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783209",
            "telephone_number": "310-542-6988",
            "fax_number": "310-542-3182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED C. STALLEY,D.D.S. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "STALLEY",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "310-542-6988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "28095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redondo Beach Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.