Active NPI
Gabrielle Jannotta
- Dentist
- Costa Mesa, CA
National Provider Identifier
1174176515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104061
- Practice address
- 270 E 17TH St Ste 15
Costa Mesa, CA 92627-3845 - Phone
- (714) 224-0480
- NPI assigned
- Jul 23, 2019
- Last updated
- Oct 11, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 104061 | CA | Primary |
Addresses
Primary practice location
270 E 17TH St Ste 15
Costa Mesa, CA 92627-3845
Mailing address
270 E 17TH St Ste 15
Costa Mesa, CA 92627-3845
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 |
|---|---|---|---|
| 104061 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clint Walker Dental Corporation | Dentist | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba 17th Street Modern Dentistry Dental Group
- Dentist
- Costa Mesa, CA
- NPI 1790273829
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570752000000",
"number": "1174176515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "270 E 17TH ST STE 15",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926273845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "270 E 17TH ST STE 15",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926273845",
"telephone_number": "714-224-0480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANNOTTA",
"first_name": "GABRIELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-23",
"last_updated": "2019-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.