NPIMap

Organization Active NPI

Central Coast Pediatric Dental Group

  • Pediatric Dentistry
  • Salinas, CA
National Provider Identifier
1205922705
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
37400 Issued in CA
Legal business name
CENTRAL COAST PEDIATRIC DENTAL GROUP
Practice address
633 E Alvin Dr Ste B
Salinas, CA 93906-3000
Phone
(831) 443-1177
Fax
(831) 443-0705
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Anna M Lizaola
Title
Administrative Assistant
Phone
(831) 442-8878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 37400 CA Primary

Addresses

Primary practice location

633 E Alvin Dr Ste B
Salinas, CA 93906-3000

Mailing address

631 E Alvin Drive
Suite C
Salinas, CA 93906
Phone (831) 442-8878

Other identifiers 1

IdentifierTypeStateIssuer
G9087502MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Central Coast Pediatric Dental Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

633 E Alvin Dr
Ste B
Salinas, CA 93906
Phone (831) 443-1177

631 E Alvin Dr
Ste B
Salinas, CA 93906
Phone (831) 443-1177

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1205922705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 E ALVIN DRIVE",
            "address_2": "SUITE C",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "93906",
            "telephone_number": "831-442-8878",
            "fax_number": "831-443-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 E ALVIN DR STE B",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "939063000",
            "telephone_number": "831-443-1177",
            "fax_number": "831-443-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COAST PEDIATRIC DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "LIZAOLA",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "831-442-8878"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "37400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9087502",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salinas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.