Active NPI
Samantha Erica Banzon Dela Rosa, DDS
- Dentist
- Fremont, CA
National Provider Identifier
1205693595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS109078
- Practice address
- 47000 Warm Springs Blvd
Fremont, CA 94539-7467 - Phone
- (510) 226-0988
- NPI assigned
- Mar 4, 2024
- 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 | DDS109078 | CA | Primary |
Addresses
Primary practice location
47000 Warm Springs Blvd
Fremont, CA 94539-7467
Mailing address
184 Channi Loop
Danville, CA 94506-5025
Phone (925) 786-0359
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 |
|---|---|---|---|
| DDS109078 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709510400000",
"number": "1205693595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "184 CHANNI LOOP",
"city": "DANVILLE",
"state": "CA",
"postal_code": "945065025",
"telephone_number": "925-786-0359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47000 WARM SPRINGS BLVD",
"city": "FREMONT",
"state": "CA",
"postal_code": "945397467",
"telephone_number": "510-226-0988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELA ROSA",
"first_name": "SAMANTHA",
"middle_name": "ERICA BANZON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-04",
"last_updated": "2024-03-04",
"certification_date": "2024-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS109078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.