Anthony E Deza, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

106894 Issued in CA

Practice address

23080 Alessandro Blvd Ste 201
Moreno Valley, CA 92553-9674

Phone

(951) 697-0909

NPI assigned

Sep 2, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Dr. Deza'S Dental Office Inc.

  • Dental Clinic/Center
  • Moreno Valley, CA
  • NPI 1548612856
  NPD (past)

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1245908474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18306 BERRY RD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925088869",
            "telephone_number": "951-452-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23080 ALESSANDRO BLVD STE 201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539674",
            "telephone_number": "951-697-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEZA",
        "first_name": "ANTHONY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106894",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Developmental Client Care
• Developmental Client Care
• Shawn Patrick Devitt, DO
• Ruth Dewoskin, PA-C
• Abraham Nilton Deza Rolando
• Rocio D Deza, DDS
• Navpreet Kaur Dhillon, MD
• Ravneet Singh Dhillon, DDS
• Sayali Arunkumar Dhuri, PT DPT
• Diane Boval DDS a Professional Dental Corp

• Dentist in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.