Sandy Priyawat, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

110348 Issued in CA

Practice address

2071 Rancho Valley Dr Ste 140
Pomona, CA 91766-7105

Phone

(909) 374-1815

NPI assigned

Jul 23, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Awad and Moore Dental Corporation

  • Dentist
  • Pomona, CA
  • NPI 1033506282
  NPD (past)

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1316775166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 S STATE COLLEGE BLVD UNIT 460",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928211617",
            "telephone_number": "951-905-4058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2071 RANCHO VALLEY DR STE 140",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917667105",
            "telephone_number": "909-374-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIYAWAT",
        "first_name": "SANDY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "110348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Prieto, BA
• Primary Critical Care Limited Partnership
• Primary Reliance Inc
• Prime One Care LLC
• Pristine Medical Group
• Pro Angels Inc
• Pro-Health Community Care
• Vikki Lauran Prochorchik
• Eric Proctor
• Professional Wound Specialists PC

• Dentist in Pomona, CA
• Providers in Pomona, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.