M Elder Dental Group Corporation

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

M ELDER DENTAL GROUP CORPORATION

Practice address

704 Blossom Hill Rd Ste 102
San Jose, CA 95123-5403

Phone

(408) 225-5000

NPI assigned

Jun 28, 2019

Organization subpart

No

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

Authorized official

Name

Emmy Montes

Title

Director of Centralized Billing

Phone

(415) 246-6305

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Ned Leonard Nix, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • San Jose, CA
  • NPI 1639275217
  NPD (past)
• Shahin Taghikhan, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • San Jose, CA
  • NPI 1861806507
  NPD (past)

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561680000000",
    "number": "1215599394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 MERLOT LN",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945031243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 BLOSSOM HILL RD STE 102",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951235403",
            "telephone_number": "408-225-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M ELDER DENTAL GROUP CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-28",
        "last_updated": "2019-06-28",
        "status": "A",
        "authorized_official_last_name": "MONTES",
        "authorized_official_first_name": "EMMY",
        "authorized_official_title_or_position": "DIRECTOR OF CENTRALIZED BILLING",
        "authorized_official_telephone_number": "415-246-6305"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrei Lyovin, PH.D.
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• Youngsu Lyu, DC
• Gretta M Johnson
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• M. Asadi, D.D.S., Inc.
• M. Tranduc M.D., Inc

• Oral and Maxillofacial Surgery (Dentist) in San Jose, CA
• Providers in San Jose, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; 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.