NPIMap

Organization Active NPI

Chula Vista Dental Care

  • General Practice Dentistry
  • Chula Vista, CA
National Provider Identifier
1174741532
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
40946 Issued in CA
Legal business name
CHULA VISTA DENTAL CARE
Practice address
1177 Broadway Ste 19
Chula Vista, CA 91911-2771
Phone
(619) 409-1400
NPI assigned
Apr 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Manijeh Maroon, D.D.S., F.I.C.O.I.
Title
President
Phone
(619) 409-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 40946 CA Primary

Addresses

Primary practice location

1177 Broadway Ste 19
Chula Vista, CA 91911-2771

Mailing address

1177 Broadway Ste 19
Chula Vista, CA 91911-2771

National Provider Directory

National Provider Directory
Tax ID family
Chula Vista Dental Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1177 Broadway
Ste 19
Chula Vista, CA 91911
Phone (619) 409-1400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174741532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 BROADWAY STE 19",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919112771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 BROADWAY STE 19",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919112771",
            "telephone_number": "619-409-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHULA VISTA DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAROON",
        "authorized_official_first_name": "MANIJEH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-409-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., F.I.C.O.I."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.