NPIMap

Organization Active NPI

Diamond Springs Dental

  • Dentist
  • Diamond Springs, CA
National Provider Identifier
1235377623
Registry record updated Oct 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D43010 Issued in CA
Legal business name
DIAMOND SPRINGS DENTAL
Practice address
540 Main Street
Ste. 102 Post Office Box 500
Diamond Springs, CA 95619-0500
Phone
(530) 344-0290
Fax
(530) 344-0291
NPI assigned
Jan 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2010

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

Authorized official

Name
Dr. Mitchell A Goodis, DDSNPI 1851495147
Title
Dentist
Phone
(530) 344-0290

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D43010 CA Primary

Addresses

Primary practice location

540 Main Street
Ste. 102 Post Office Box 500
Diamond Springs, CA 95619-0500

Mailing address

PO Box 500
Ste. 102
Diamond Springs, CA 95619-0500
Phone (530) 344-0290

Other identifiers 1

IdentifierTypeStateIssuer
130082OtherCAUMITED CONCORDIA

Other names 1

  • Pleasant Valley Dental, General Dental Practice of Mitchell A. Goodis, Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Diamond Springs Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

540 Pleasant Valley Rd
Ste 102
Diamond Springs, CA 95619
Phone (530) 344-0290

Practitioners & affiliated clinicians

Practitioners 1

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": "1232668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286150400000",
    "number": "1235377623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "address_2": "STE. 102",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956190500",
            "telephone_number": "530-344-0290",
            "fax_number": "530-344-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 MAIN STREET",
            "address_2": "STE. 102 POST OFFICE BOX 500",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956190500",
            "telephone_number": "530-344-0290",
            "fax_number": "530-344-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMOND SPRINGS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-23",
        "last_updated": "2010-10-04",
        "status": "A",
        "authorized_official_last_name": "GOODIS",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "530-344-0290",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "D43010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMITED CONCORDIA",
            "identifier": "130082",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pleasant Valley Dental, General Dental Practice of Mitchell A. Goodis,",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Diamond Springs, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; 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.