NPIMap

Organization Active NPI

Untalan Dental Corporation

  • General Practice Dentistry
  • Pacoima, CA
National Provider Identifier
1245357789
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
49693 Issued in CA
Legal business name
UNTALAN DENTAL CORPORATION
Practice address
10750 Glenoaks Blvd
Suite 6
Pacoima, CA 91331-1690
Phone
(818) 686-1400
Fax
(818) 686-1411
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Charise R Untalan II
Title
VP
Phone
(213) 385-3828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 49693 CA Primary

Addresses

Primary practice location

10750 Glenoaks Blvd
Suite 6
Pacoima, CA 91331-1690

Mailing address

10750 Glenoaks Blvd
Suite 6
Pacoima, CA 91331-1690
Phone (818) 686-1400

Other identifiers 2

IdentifierTypeStateIssuer
249693OtherCADELTA DENTAL ID NUMB
G9241202OtherCADENTICAL PROV NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Untalan Dental Corporation2 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

10750 Glenoaks Blvd
Ste 6
Pacoima, CA 91331
Phone (818) 686-1400

Practitioners & affiliated clinicians

Practitioners 2

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": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245357789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10750 GLENOAKS BLVD",
            "address_2": "SUITE 6",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311690",
            "telephone_number": "818-686-1400",
            "fax_number": "818-686-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10750 GLENOAKS BLVD",
            "address_2": "SUITE 6",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311690",
            "telephone_number": "818-686-1400",
            "fax_number": "818-686-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNTALAN DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "UNTALAN",
        "authorized_official_first_name": "CHARISE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "213-385-3828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL ID NUMB",
            "identifier": "249693",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL PROV NUMBER",
            "identifier": "G9241202",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacoima, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.