A Dental Group of William E. Vickerman DDS

Primary specialty

DentistTaxonomy code 122300000X

License

27704 Issued in CA

Legal business name

A DENTAL GROUP OF WILLIAM E. VICKERMAN DDS

Practice address

18000 Studebaker Rd Ste 365
Cerritos, CA 90703-2690

Phone

(562) 202-5741

NPI assigned

Jul 7, 2015

Last updated

Jul 7, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Benson B. Dimaranan, BSC, RPHT, RDA, OAP

Title

Administrative Director

Phone

(562) 202-5741

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436227200000",
    "number": "1356724587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 STUDEBAKER RD STE 365",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032690",
            "telephone_number": "562-202-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18000 STUDEBAKER RD STE 365",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032690",
            "telephone_number": "562-202-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A DENTAL GROUP OF WILLIAM E. VICKERMAN DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-07",
        "status": "A",
        "authorized_official_last_name": "DIMARANAN",
        "authorized_official_first_name": "BENSON",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "562-202-5741",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BSC, RPHT, RDA, OAP"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "27704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 1 Saint LLC (1 Saint)
• 4610 Psychotherapy Services, Inc.
• A Place Where There's Hope
• A Real Care and Staffing, Inc.
• Caron Faustino Marti Chua Abalos
• Gabriel Sami Abboud
• Abc Unified School District

• Dentist in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; 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.