Erline Diona Poerwanto, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

62687 Issued in CA

Practice address

2155 Webster Street
San Francisco, CA 94115

Phone

(209) 910-3505

NPI assigned

Sep 27, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: epoerwanto@direct.westerndental.com

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

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380240000000",
    "number": "1194152736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7194",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 WEBSTER STREET",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94115",
            "telephone_number": "209-910-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POERWANTO",
        "first_name": "ERLINE",
        "middle_name": "DIONA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-27",
        "last_updated": "2013-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62687",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liina Poder, M.D.
• Podiatry Plan Inc
• Richard A. Podolin, MD
• Laura Podwoski, LCSW
• William Edward Poe III
• Gloria Poessy, LCSW
• Alexa Poeter
• Rosa Poggesi
• Jacqueline M. Poggi, MD
• Roza Poghosyan, DDS

• General Practice Dentistry in San Francisco, CA
• Providers in San Francisco, 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 Sep 27, 2013; 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.