NPIMap

Organization Active NPI

Kerry a. Booth,D.D.S., Inc

  • Dentist
  • El Cajon, CA
National Provider Identifier
1154335404
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
24947 Issued in CA
Legal business name
KERRY A. BOOTH,D.D.S., INC
Practice address
2990 Jamacha Rd
Suite 140
El Cajon, CA 92019-4376
Phone
(619) 670-5133
Fax
(619) 670-1492
NPI assigned
Jul 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kerry A Booth, DDS
Title
President
Phone
(619) 670-5133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 24947 CA Primary

Addresses

Primary practice location

2990 Jamacha Rd
Suite 140
El Cajon, CA 92019-4376

Mailing address

2990 Jamacha Rd
Suite 140
El Cajon, CA 92019-4376
Phone (619) 670-5133

National Provider Directory

National Provider Directory

Locations

2990 Jamacha Rd
Ste 140
El Cajon, CA 92019
Phone (619) 670-5133

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154335404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 JAMACHA RD",
            "address_2": "SUITE 140",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920194376",
            "telephone_number": "619-670-5133",
            "fax_number": "619-670-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 JAMACHA RD",
            "address_2": "SUITE 140",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920194376",
            "telephone_number": "619-670-5133",
            "fax_number": "619-670-1492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY A. BOOTH,D.D.S., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-670-5133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "24947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Cajon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.