Active NPI
Mariko Choetsopon Oda, D.M.D.
- Dentist
- Ontario, CA
National Provider Identifier
1174976831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS100412
- Practice address
- 3640 Honey Glen Way
Ontario, CA 91761-0124 - Phone
- (912) 577-5404
- NPI assigned
- Jul 18, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | DDS100412 | CA | Primary |
Addresses
Primary practice location
3640 Honey Glen Way
Ontario, CA 91761-0124
Mailing address
3640 Honey Glen Way
Ontario, CA 91761-0124
Phone (912) 577-5404
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170622000639 | CA | Order and Referring Only - Dentist | 8729356340 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS100412 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468800000000",
"number": "1174976831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3640 HONEY GLEN WAY",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917610124",
"telephone_number": "912-577-5404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3640 HONEY GLEN WAY",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917610124",
"telephone_number": "912-577-5404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODA",
"first_name": "MARIKO",
"middle_name": "CHOETSOPON",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-18",
"last_updated": "2016-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS100412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.