Active NPI
Ajay Varghese, DMD
- Periodontics
- Tustin, CA
National Provider Identifier
1144939091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DDS111275
- Practice address
- 12569 Newport Ave
Tustin, CA 92780-2420 - Phone
- (714) 544-2220
- NPI assigned
- Nov 18, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN.00205400 | CO | |
| Periodontics | 1223P0300X | DDS111275 | CA | Primary |
Addresses
Primary practice location
12569 Newport Ave
Tustin, CA 92780-2420
Mailing address
12569 Newport Ave
Tustin, CA 92780-2420
Phone (714) 544-2220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN.00205400 | CO | MD | Dentist |
| DDS111275 | CA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ajay Varghese, DMD, Inc | Dentist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752796800000",
"number": "1144939091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12569 NEWPORT AVE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927802420",
"telephone_number": "714-544-2220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12569 NEWPORT AVE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927802420",
"telephone_number": "714-544-2220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARGHESE",
"first_name": "AJAY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-18",
"last_updated": "2025-07-18",
"certification_date": "2025-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "DEN.00205400",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "DDS111275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.