Edgardo A. De la Vega, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22336 Issued in CA

Practice address

22114 Roscoe Blvd
Canoga Park, CA 91304-3838

Phone

(818) 348-8713

NPI assigned

Apr 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Ebi Nikjoo Dental Corp

  • Dental Clinic/Center
  • Canoga Park, CA
  • NPI 1508583659
  NPD (past)

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

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164544573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22114 ROSCOE BLVD",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913043838",
            "telephone_number": "818-348-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22114 ROSCOE BLVD",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913043838",
            "telephone_number": "818-348-8713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA VEGA",
        "first_name": "EDGARDO",
        "middle_name": "A.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "22336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine De la Cruz
• Evelyn De la Luz Rojas
• Jaqueline De la Luz
• Alma De la Rosa
• Yvonne De la Rosa
• Rebecca De Luca
• Michelle De Paz
• Samantha Dea
• Faranak Dehghan-Abnavi, DC
• Chelsey Dekker

• General Practice Dentistry in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• General Practice Dentistry in California

• 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.

Verify at the official NPI Registry.