Individual provider Active NPI

Roy J. Vegter, D.D.S.

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1205988037
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
58955 Issued in CA
Practice address
4276 54TH PL Ste D
San Diego, CA 92115-6011
Phone
(518) 281-1229
Fax
(619) 265-0566
NPI assigned
Jan 18, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 58955 CA Primary

Addresses

Primary practice location

4276 54TH PL Ste D
San Diego, CA 92115-6011

Mailing address

3535 Bear Dr
San Diego, CA 92103-3902
Phone (518) 281-7880

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

LicenseStateTypeSpecialty
58955CAMDMedical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1205988037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 BEAR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033902",
            "telephone_number": "518-281-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4276 54TH PL STE D",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921156011",
            "telephone_number": "518-281-1229",
            "fax_number": "619-265-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VEGTER",
        "first_name": "ROY",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.