Active NPI
West Cobb Dentist Office, PC
- Dentist
- Irvine, CA
National Provider Identifier
1144761727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- WEST COBB DENTIST OFFICE, PC
- Practice address
- 17000 Red Hill Ave
Irvine, CA 92614-5626 - Phone
- (678) 203-3464
- NPI assigned
- Mar 15, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jonathan Bridwell
- Title
- Credentialing Admin
- Phone
- (714) 845-8231
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | Primary |
Addresses
Primary practice location
17000 Red Hill Ave
Irvine, CA 92614-5626
Mailing address
3805 Dallas Hwy SW
Suite 804
Marietta, GA 30064
National Provider Directory
National Provider Directory- Tax ID family
- West Cobb Dentist Office
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489536000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1489536000000",
"number": "1144761727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3805 DALLAS HWY SW",
"address_2": "SUITE 804",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17000 RED HILL AVE",
"city": "IRVINE",
"state": "CA",
"postal_code": "926145626",
"telephone_number": "678-203-3464"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WEST COBB DENTIST OFFICE, PC",
"organizational_subpart": "NO",
"enumeration_date": "2017-03-15",
"last_updated": "2017-03-15",
"status": "A",
"authorized_official_last_name": "BRIDWELL",
"authorized_official_first_name": "JONATHAN",
"authorized_official_title_or_position": "CREDENTIALING ADMIN",
"authorized_official_telephone_number": "714-845-8231"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.