NPIMap

Organization Active NPI

Greater Modesto Dental Implant &Oral Surgery Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Modesto, CA
National Provider Identifier
1326468752
Registry record updated Jul 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
32447 Issued in CA
Legal business name
GREATER MODESTO DENTAL IMPLANT &ORAL SURGERY CENTER
Practice address
201 E Orangeburg Ave
Suite a
Modesto, CA 95350-5355
Phone
(209) 527-5050
Fax
(209) 527-0659
NPI assigned
Apr 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2016

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

Authorized official

Name
Victoria Bruno
Title
Administrator
Phone
(209) 527-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 32447 CA Primary

Addresses

Primary practice location

201 E Orangeburg Ave
Suite a
Modesto, CA 95350-5355

Mailing address

201 E Orangeburg Ave
Suite a
Modesto, CA 95350-5355
Phone (209) 527-5050

National Provider Directory

National Provider Directory

Locations

201 E Orangeburg Ave
Ste A
Modesto, CA 95350
Phone (209) 527-5050

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": "1398297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467331200000",
    "number": "1326468752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E ORANGEBURG AVE",
            "address_2": "SUITE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505355",
            "telephone_number": "209-527-5050",
            "fax_number": "209-527-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E ORANGEBURG AVE",
            "address_2": "SUITE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505355",
            "telephone_number": "209-527-5050",
            "fax_number": "209-527-0659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER MODESTO DENTAL IMPLANT &ORAL SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-24",
        "last_updated": "2016-07-01",
        "status": "A",
        "authorized_official_last_name": "BRUNO",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "209-527-5050"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "32447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.