Active NPI
Gregory Blake Apostle
- Pediatric Dentistry
- Santa Rosa, CA
National Provider Identifier
1164526521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 42114
- Practice address
- 95 Montgomery Dr
#210
Santa Rosa, CA 95404 - Phone
- (707) 542-4746
- Fax
- (707) 544-7041
- NPI assigned
- Sep 7, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 42114 | CA | Primary |
Addresses
Primary practice location
95 Montgomery Dr
#210
Santa Rosa, CA 95404
Mailing address
95 Montgomery Dr
#210
Santa Rosa, CA 95404
Phone (707) 542-4746
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42114 | Other | CA | DENTAL LIC NUMBER |
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 |
|---|---|---|---|
| 42114 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164526521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 MONTGOMERY DR",
"address_2": "#210",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95404",
"telephone_number": "707-542-4746",
"fax_number": "707-544-7041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "95 MONTGOMERY DR",
"address_2": "#210",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95404",
"telephone_number": "707-542-4746",
"fax_number": "707-544-7041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "APOSTLE",
"first_name": "GREGORY",
"middle_name": "BLAKE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "42114",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LIC NUMBER",
"identifier": "42114",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.