NPIMap

Organization Active NPI

Pacific Dental Clinic

  • General Practice Dentistry
  • Moreno Valley, CA
National Provider Identifier
1326381450
Registry record updated Mar 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
47897 Issued in CA
Legal business name
PACIFIC DENTAL CLINIC
Practice address
25025 Red Maple LN
Moreno Valley, CA 92551-1137
Phone
(951) 924-6370
Fax
(951) 924-6374
NPI assigned
Mar 27, 2013
Last updated
Mar 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2013

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

Authorized official

Name
Dr. Jorge L Geronimo, D.D.S.
Title
Dentist
Phone
(951) 924-6370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 47897 CA Primary

Addresses

Primary practice location

25025 Red Maple LN
Moreno Valley, CA 92551-1137

Mailing address

25025 Red Maple LN
Moreno Valley, CA 92551
Phone (951) 924-6370

National Provider Directory

National Provider Directory
Tax ID family
Jorge L Geronimo Ddsprofdental Cor5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

25025 Red Maple Ln
Moreno Valley, CA 92551
Phone (951) 924-6370

NPI Registry JSON

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364342400000",
    "number": "1326381450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25025 RED MAPLE LN",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "92551",
            "telephone_number": "951-924-6370",
            "fax_number": "951-924-6374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25025 RED MAPLE LN",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925511137",
            "telephone_number": "951-924-6370",
            "fax_number": "951-924-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-27",
        "last_updated": "2013-03-27",
        "status": "A",
        "authorized_official_last_name": "GERONIMO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "951-924-6370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; 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.