Arrowhead Community Surgical Medical Group, Inc.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

51201 Issued in CA

Legal business name

ARROWHEAD COMMUNITY SURGICAL MEDICAL GROUP, INC.

Practice address

400 N Pepper Ave
Surgery Department
Colton, CA 92324-1801

Phone

(909) 580-6210

Fax

(909) 580-1363

NPI assigned

Jan 8, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Appanagari Gnanadev, MD.

Title

President

Phone

(909) 580-6210

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245388032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923730221",
            "telephone_number": "909-580-6210",
            "fax_number": "909-580-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "address_2": "SURGERY DEPARTMENT",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-6210",
            "fax_number": "909-580-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARROWHEAD COMMUNITY SURGICAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GNANADEV",
        "authorized_official_first_name": "APPANAGARI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-580-6210",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "51201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00SP18300",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0079700",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Colton, CA
• Providers in Colton, CA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in California

• 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.