NPIMap

Organization Active NPI

Petaluma Valley Dental

Doing business as Dinu A Gray/Myrna Menjivar Gray

  • General Practice Dentistry
  • Petaluma, CA
National Provider Identifier
1356438311
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30461 Issued in CA
Legal business name
PETALUMA VALLEY DENTAL
Doing business as
Dinu A Gray/Myrna Menjivar Gray
Practice address
701 Sonoma Mountain Pkwy
Suite E 1
Petaluma, CA 94954-8518
Phone
(707) 782-0789
Fax
(707) 782-9133
NPI assigned
Oct 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Myrna Menjivar, DDS
Title
Partner
Phone
(415) 299-9566

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30461 CA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30433 CA

Addresses

Primary practice location

701 Sonoma Mountain Pkwy
Suite E 1
Petaluma, CA 94954-8518

Mailing address

188 Stanford Ave
Mill Valley, CA 94941-3546
Phone (415) 389-9566

Other names 1

  • Dinu A Gray/Myrna Menjivar Gray Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356438311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 STANFORD AVE",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413546",
            "telephone_number": "415-389-9566",
            "fax_number": "415-389-9563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SONOMA MOUNTAIN PKWY",
            "address_2": "SUITE E 1",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949548518",
            "telephone_number": "707-782-0789",
            "fax_number": "707-782-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALUMA VALLEY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MENJIVAR",
        "authorized_official_first_name": "MYRNA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "415-299-9566",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30461",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30433",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dinu A Gray/Myrna Menjivar Gray",
            "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 Aug 22, 2020; 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.