Active NPI
Christopher Reuben Tataryn, DDS
- Dentist
- Montclair, CA
National Provider Identifier
1194502492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 109299
- Practice address
- 5275 Holt Blvd Ste E
Montclair, CA 91763-4822 - Phone
- (909) 616-5050
- NPI assigned
- Sep 11, 2023
- Sex
- Male
- Sole proprietor
- No
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 | 109299 | CA | Primary |
Addresses
Primary practice location
5275 Holt Blvd Ste E
Montclair, CA 91763-4822
Mailing address
250 N College Park Dr Apt O33
Upland, CA 91786-9413
Phone (509) 638-2046
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109299 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694390400000",
"number": "1194502492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N COLLEGE PARK DR APT O33",
"city": "UPLAND",
"state": "CA",
"postal_code": "917869413",
"telephone_number": "509-638-2046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5275 HOLT BLVD STE E",
"city": "MONTCLAIR",
"state": "CA",
"postal_code": "917634822",
"telephone_number": "909-616-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATARYN",
"first_name": "CHRISTOPHER",
"middle_name": "REUBEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-11",
"last_updated": "2023-09-11",
"certification_date": "2023-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "109299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montclair, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.