Jorge Enciso, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

104037 Issued in CA

Practice address

10683 Magnolia Ave Ste D
Riverside, CA 92505-1893

Phone

(951) 324-1212

NPI assigned

Sep 10, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jorge Enciso-Carmona Jr. Former name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Jorge Enciso, DDS, Inc.

  • Dental Clinic/Center
  • Yucaipa, CA
  • NPI 1447829338
  NPD Authorized official

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1194374439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13554 DOUGLAS ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995517",
            "telephone_number": "909-910-5824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10683 MAGNOLIA AVE STE D",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925051893",
            "telephone_number": "951-324-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENCISO",
        "first_name": "JORGE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "104037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORGE",
            "last_name": "ENCISO-CARMONA",
            "suffix": "JR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Alyssa Endicott
• Endocrine Associates of Riverside a Professional Corporation
• Energy Chiropractic Center Inc.
• Energy Is Life Local Advocacy
• Enerje Wellness Licenced Clinical Social Worker

• General Practice Dentistry in Riverside, CA
• Providers in Riverside, 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 10, 2019; 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.

Verify at the official NPI Registry.