Active NPI
Mario Pureco, D.D.S
- General Practice Dentistry
- Upland, CA
National Provider Identifier
1194957969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 58625
- Practice address
- 485 E Foothill Blvd
Upland, CA 91786-3987 - Phone
- (909) 256-0090
- Fax
- (909) 256-0092
- NPI assigned
- Aug 12, 2009
- Last updated
- Jan 23, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 58625 | CA | Primary |
Addresses
Primary practice location
485 E Foothill Blvd
Upland, CA 91786-3987
Mailing address
485 E Foothill Blvd Ste E
Upland, CA 91786-3987
Phone (909) 256-0090
Other practice location 1
1541 S Garey Ave
Pomona, CA 91766-5222
Phone (909) 469-6485
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pureco Dental Group Inc | Current | Accepting new patients | |
| Pureco Dental Practice Inc | Current | Accepting new patients | |
| Mario Pureco, D.D.S.,Inc. | General Practice | Past | Accepting new patients |
| Savneet Anand DDS Inc. | Past | Accepting new patients |
Locations
485 E Foothill Blvd
Ste E
Upland, CA 91786
Phone (909) 256-0090
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Upland, CA
- NPI 1376197954
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674432000000",
"number": "1194957969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "485 E FOOTHILL BLVD STE E",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863987",
"telephone_number": "909-256-0090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "485 E FOOTHILL BLVD",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863987",
"telephone_number": "909-256-0090",
"fax_number": "909-256-0092"
}
],
"practiceLocations": [
{
"address_1": "1541 S Garey Ave",
"address_purpose": "LOCATION",
"city": "Pomona",
"state": "CA",
"postal_code": "917665222",
"country_code": "US",
"telephone_number": "909-469-6485",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PURECO",
"first_name": "MARIO",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-12",
"last_updated": "2023-01-23",
"certification_date": "2023-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "58625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.