NPIMap

Organization Active NPI

Leah Deberardinis DDS and Austin Griffith DDS a Dental Corporation

  • General Practice Dentistry
  • Petaluma, CA
National Provider Identifier
1316969496
Registry record updated Sep 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
51523 Issued in CA
Legal business name
LEAH DEBERARDINIS DDS AND AUSTIN GRIFFITH DDS A DENTAL CORPORATION
Practice address
511 Hayes LN.
Petaluma, CA 94952
Phone
(707) 763-2654
Fax
(707) 763-3141
NPI assigned
Jul 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2016

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

Authorized official

Name
Dr. Leah Deberardinis, DDSNPI 1396947693
Title
President/ Treasurer
Phone
(707) 763-2654

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 51523 CA Primary

Addresses

Primary practice location

511 Hayes LN.
Petaluma, CA 94952

Mailing address

511 Hayes LN
Petaluma, CA 94952-4011
Phone (707) 763-2654

Other names 1

  • Hillcrest Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

511 Hayes Ln
Petaluma, CA 94952
Phone (707) 763-2654

Practitioners & affiliated clinicians

Practitioners 6

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": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473292800000",
    "number": "1316969496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 HAYES LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949524011",
            "telephone_number": "707-763-2654",
            "fax_number": "707-763-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 HAYES LN.",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "94952",
            "telephone_number": "707-763-2654",
            "fax_number": "707-763-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAH DEBERARDINIS DDS AND AUSTIN GRIFFITH DDS A DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2016-09-08",
        "status": "A",
        "authorized_official_last_name": "DEBERARDINIS",
        "authorized_official_first_name": "LEAH",
        "authorized_official_title_or_position": "PRESIDENT/ TREASURER",
        "authorized_official_telephone_number": "707-763-2654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hillcrest Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.