Active NPI
John Wilson Faris III, D.D.S.
- General Practice Dentistry
- Long Beach, CA
National Provider Identifier
1255437265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 21308
- Practice address
- 3821 Atlantic Ave
Suite D
Long Beach, CA 90807-3534 - Phone
- (562) 424-8666
- Fax
- (562) 426-6189
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21308 | CA | Primary |
Addresses
Primary practice location
3821 Atlantic Ave
Suite D
Long Beach, CA 90807-3534
Mailing address
3821 Atlantic Ave
Suite D
Long Beach, CA 90807-3534
Phone (562) 424-8666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2017 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21308 | CA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255437265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3821 ATLANTIC AVE",
"address_2": "SUITE D",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908073534",
"telephone_number": "562-424-8666",
"fax_number": "562-426-6189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3821 ATLANTIC AVE",
"address_2": "SUITE D",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908073534",
"telephone_number": "562-424-8666",
"fax_number": "562-426-6189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARIS",
"first_name": "JOHN",
"middle_name": "WILSON",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "21308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.