Grace Catherine Fedor, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1000550 Issued in CA

Practice address

5638 Mission Center Rd
Ste 107
San Diego, CA 92108-4348

Phone

(619) 220-0159

NPI assigned

Jul 27, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Grace Liu Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Lance Rygg Professional Dental Corporation

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1366701096
  NPD (past)

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

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469577600000",
    "number": "1174076004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11253 MIRO CIR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313313",
            "telephone_number": "661-203-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5638 MISSION CENTER RD",
            "address_2": "STE 107",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084348",
            "telephone_number": "619-220-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDOR",
        "first_name": "GRACE",
        "middle_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-27",
        "last_updated": "2016-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "1000550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "LIU",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chloe Ysabel Esteban Federe, DMD
• Jay Beckett Federhart, MD
• Janette Federico
• Edward Charles Federman, M.D.
• Fedor Dental Corporation
• Kenneth M Fedor, D.D.S.
• Elena Fedorovykh
• Michael Fedorshak
• Ekaterina A Fedoseeva
• Dara Fedrow

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, 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 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.