Amanda Jacovani, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

106923 Issued in CA

Practice address

2878 Campus Pkwy Ste 1
Riverside, CA 92507-0945

Phone

(951) 571-0011

NPI assigned

Sep 1, 2021

Sex

Female

Sole proprietor

No

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

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

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.

• Carlisle and Rodgers Dental Corporation

  • General Practice Dentistry
  • Riverside, CA
  • NPI 1093800864
  NPD (past)

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1235807504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 SONORA CIR",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738510",
            "telephone_number": "951-236-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2878 CAMPUS PKWY STE 1",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925070945",
            "telephone_number": "951-571-0011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27110 Eucalyptus Ave",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925554542",
            "country_code": "US",
            "telephone_number": "951-616-1759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOVANI",
        "first_name": "AMANDA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "106923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry James Jacobsen, Jr., MA, LMFT
• Tracy Jacobsen
• Ralph Olav Jacobsson, LCSW
• Heidi Jacome
• Samantha Mercedes Jacome
• Jacqueline G. Agcaoili, MD Corporation
• Tiffany Ashley Jacquette, LVN
• Ivan Jacuinde
• Victoria Jacuinde, BCBA
• Faith Isabella Jaen

• General Practice Dentistry in Riverside, CA
• Providers in Riverside, 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 Sep 1, 2021; 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.