Individual provider Active NPI

Effuah A Harris, DDS

  • General Practice Dentistry
  • Upland, CA
National Provider Identifier
1174623706
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
43672 Issued in CA
Practice address
258 E 9TH St
Upland, CA 91786-6017
Phone
(909) 946-3433
Fax
(909) 946-3434
NPI assigned
Sep 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 43672 CA Primary

Addresses

Primary practice location

258 E 9TH St
Upland, CA 91786-6017

Mailing address

258 E 9TH St
Upland, CA 91786-6017
Phone (909) 946-3433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180926002319 CA Practitioner - Oral Surgery 6901118504 Reassigns benefits to 1 organization
I20240326003354 TX Practitioner - Dentist 6901118504 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
43672CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Western University of Health Sciences Current Accepting new patients
Northern Valley Indian Health Inc CurrentSince Mar 11, 2024 Accepting new patients
Northern Valley Indian Health Inc Current Accepting new patients
Northern Valley Indian Health, Inc CurrentSince Mar 11, 2024 Accepting new patients
Western University of Health Sciences CurrentSince Aug 1, 2018 Accepting new patients
Western University of Health Sciences CurrentSince Aug 1, 2018 Accepting new patients

Locations

795 E 2nd St
Ste 8
Pomona, CA 91766
Phone (909) 469-8673

795 E 2nd St
Ste 5
Pomona, CA 91766
Phone (909) 706-3877

207 N Butte St
Willows, CA 95988
Phone (530) 934-4641

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257206400000",
    "number": "1174623706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 E 9TH ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866017",
            "telephone_number": "909-946-3433",
            "fax_number": "909-946-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 E 9TH ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866017",
            "telephone_number": "909-946-3433",
            "fax_number": "909-946-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "EFFUAH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2009-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.