NPIMap

Organization Active NPI

Nicholas Poblete, D.D.S., Inc.

  • Dentist
  • Modesto, CA
National Provider Identifier
1336340165
Registry record updated Sep 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
49190 Issued in CA
Legal business name
NICHOLAS POBLETE, D.D.S., INC.
Practice address
1316 Coffee Rd
BLDG. C
Modesto, CA 95355-3191
Phone
(209) 521-6822
Fax
(209) 521-0466
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2011

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

Authorized official

Name
Dr. Nicholas Ellis Poblete, D.D.S.NPI 1043621618
Title
Dentist
Phone
(209) 521-6822

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 49190 CA Primary

Addresses

Primary practice location

1316 Coffee Rd
BLDG. C
Modesto, CA 95355-3191

Mailing address

1316 Coffee Rd
BLDG. C
Modesto, CA 95355-3191
Phone (209) 521-6822

National Provider Directory

National Provider Directory

Locations

1316 Coffee Rd
Bldg C
Modesto, CA 95355
Phone (209) 521-6822

Practitioners & affiliated clinicians

Practitioners 1

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": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315353600000",
    "number": "1336340165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 COFFEE RD",
            "address_2": "BLDG. C",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953553191",
            "telephone_number": "209-521-6822",
            "fax_number": "209-521-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 COFFEE RD",
            "address_2": "BLDG. C",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953553191",
            "telephone_number": "209-521-6822",
            "fax_number": "209-521-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLAS POBLETE, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2011-09-07",
        "status": "A",
        "authorized_official_last_name": "POBLETE",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "ELLIS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "209-521-6822",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "49190",
            "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 Sep 7, 2011; 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.