Vincent Matthew Mardesich, DDS.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

35430 Issued in CA

Practice address

1360 W 6TH St
Ste. 210 ,West Building
San Pedro, CA 90732-3514

Phone

(310) 514-1000

Fax

(310) 514-1005

NPI assigned

Aug 15, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235242306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 W 6TH ST",
            "address_2": "STE. 210 ,WEST BUILDING",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323514",
            "telephone_number": "310-514-1000",
            "fax_number": "310-514-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 W 6TH ST",
            "address_2": "STE. 210 ,WEST BUILDING",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323514",
            "telephone_number": "310-514-1000",
            "fax_number": "310-514-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARDESICH",
        "first_name": "VINCENT",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "35430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in San Pedro, CA
• Providers in San Pedro, 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 Jul 8, 2007; 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.