Active NPI
Maryann Detar
- Dental Hygienist
- San Jose, CA
National Provider Identifier
1285234047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 26843
- Practice address
- 3154 Alum Rock Ave
San Jose, CA 95127-2903 - Phone
- (669) 232-0311
- NPI assigned
- Oct 29, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 26843 | CA | Primary |
Addresses
Primary practice location
3154 Alum Rock Ave
San Jose, CA 95127-2903
Mailing address
3154 Alum Rock Ave
San Jose, CA 95127-2903
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26843 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603929600000",
"number": "1285234047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3154 ALUM ROCK AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951272903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3154 ALUM ROCK AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951272903",
"telephone_number": "669-232-0311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETAR",
"first_name": "MARYANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-29",
"last_updated": "2020-10-29",
"certification_date": "2020-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "26843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.