NPIMap

Enoma Alade, DDS, Inc

Organization Active NPI Dentist · Azusa, CA

NPI 1285957712 · NPPES record last updated Mar 11, 2010

Key facts

NPI
1285957712
Entity type
Organization (NPI type 2)
Primary specialty
Dentist 122300000X
License
47979 (CA)
Legal business name
ENOMA ALADE, DDS, INC
Practice address
706 North Azusa Ave
Azusa, CA 91702-2507
Phone
(626) 334-7310
Fax
(626) 334-7311
NPI assigned
Mar 11, 2010
Organization subpart
No

Authorized official

Name
Enoma A Alade, DDS, MPH NPI 1831207240
Title
Owner Dentist
Phone
(626) 334-7310

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist
Group: 193200000X MULTI-SPECIALTY GROUP		 122300000X 47979 CA Yes

Addresses

Primary practice location

706 North Azusa Ave
Azusa, CA 91702-2507

Mailing address

706 North Azusa Ave
Azusa, CA 91702-2507
Phone (626) 334-7310

Other identifiers

IdentifierTypeStateIssuer
G933866-01MedicaidCA

Other names

  • Canyon City Dental Care Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 11, 2010.

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1285957712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 NORTH AZUSA AVE",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917022507",
            "telephone_number": "626-334-7310",
            "fax_number": "626-334-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 NORTH AZUSA AVE",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917022507",
            "telephone_number": "626-334-7310",
            "fax_number": "626-334-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENOMA ALADE, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "ALADE",
        "authorized_official_first_name": "ENOMA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "626-334-7310",
        "authorized_official_credential": "DDS, MPH"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "47979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G933866-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon City Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Azusa, CA

All providers in Azusa, CA · Dentist in California

Sources for this page

Verify at the official NPI Registry.