NPIMap

Organization Active NPI

Westside Pediatric Dental Group

  • Pediatric Dentistry
  • Santa Monica, CA
National Provider Identifier
1235506312
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
39266 Issued in CA
Legal business name
WESTSIDE PEDIATRIC DENTAL GROUP
Practice address
1304 15TH St Ste 206
Santa Monica, CA 90404-1811
Phone
(310) 451-5748
Fax
(310) 393-9528
NPI assigned
Aug 25, 2015
Last updated
Aug 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

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

Authorized official

Name
Dr. Emmanuel Bernard Gross, DDSNPI 1407839053
Title
Owner
Phone
(310) 451-5748

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 59919 CA
Pediatric Dentistry 1223P0221X 39266 CA Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 31742 CA

Addresses

Primary practice location

1304 15TH St Ste 206
Santa Monica, CA 90404-1811

Mailing address

1304 15TH St Ste 206
Santa Monica, CA 90404-1811
Phone (310) 451-5748

National Provider Directory

National Provider Directory
Tax ID family
Westside Pediatric Dental Group2 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

1304 15th St
Ste 206
Santa Monica, CA 90404
Phone (310) 451-5748

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440460800000",
    "number": "1235506312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 15TH ST STE 206",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041811",
            "telephone_number": "310-451-5748",
            "fax_number": "310-393-9528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 15TH ST STE 206",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041811",
            "telephone_number": "310-451-5748",
            "fax_number": "310-393-9528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE PEDIATRIC DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2015-08-25",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-451-5748",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "59919",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "39266",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "31742",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; 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.