NPIMap

Organization Active NPI

Elvia Juarez a Dental Corporation

  • General Practice Dentistry
  • Indio, CA
National Provider Identifier
1285796532
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41625 Issued in CA
Legal business name
ELVIA JUAREZ A DENTAL CORPORATION
Practice address
82204 US Highway 111
Indio, CA 92201-5630
Phone
(760) 775-5552
Fax
(760) 775-5002
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

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

Authorized official

Name
Elvia Juarez, DDS
Title
Dentist
Phone
(760) 775-5552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 41625 CA Primary

Addresses

Primary practice location

82204 US Highway 111
Indio, CA 92201-5630

Mailing address

82204 US Highway 111
Indio, CA 92201-5630
Phone (760) 775-5552

Other names 2

  • EJ Dental Doing business as
  • Santa Maria Dental Office Elvia Juarez Dental Corporation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210728003801 CA Part B Supplier - Clinic/Group Practice 9133522147 Receives reassigned benefits from 1 practitioner
Practice locations: Indio, CA

National Provider Directory

National Provider Directory
Tax ID family
Ej Dental6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

82204 US Highway 111
Ste A
Indio, CA 92201
Phone (760) 775-5552

82204 US Highway 111
Indio, CA 92201
Phone (760) 775-5552

31773 Temecula Pkwy
Ste A
Temecula, CA 92592
Phone (951) 302-4376

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": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668988800000",
    "number": "1285796532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82204 US HIGHWAY 111",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922015630",
            "telephone_number": "760-775-5552",
            "fax_number": "760-775-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82204 US HIGHWAY 111",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922015630",
            "telephone_number": "760-775-5552",
            "fax_number": "760-775-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELVIA JUAREZ A DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "JUAREZ",
        "authorized_official_first_name": "ELVIA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "760-775-5552",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EJ Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Santa Maria Dental Office Elvia Juarez Dental Corporation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Santa Maria Dental Office Elvia Juarez Dental Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indio, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.