Raul Juan Contreras, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

60700 Issued in CA

Practice address

2600 S Tracy Blvd
Suite 170
Tracy, CA 95376-9103

Phone

(209) 836-5441

NPI assigned

Aug 11, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Raul J Contreras Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Entabi Dental Corporation

  dba Tracy Smiles Modern Dentistry

  • General Practice Dentistry
  • Tracy, CA
  • NPI 1326359944
  NPD (past)

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1225317910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4947 HARBORD DR",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946182506",
            "telephone_number": "619-733-4676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S TRACY BLVD",
            "address_2": "SUITE 170",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953769103",
            "telephone_number": "209-836-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONTRERAS",
        "first_name": "RAUL",
        "middle_name": "JUAN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-11",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "60700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAUL",
            "last_name": "CONTRERAS",
            "middle_name": "J",
            "credential": "DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Aimee Comstock, LMSW
• Megan Constantino
• Amorett Contreras
• Araceli Contreras, PPS
• Isabel Contreras
• Alicia Cook
• Haley Cook
• Meghan Cooney
• Virginia Copeland
• Karen Corallo Trovao, RDHAP

• General Practice Dentistry in Tracy, CA
• Providers in Tracy, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.