Portable Dental Diagnostic Services

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

63128 Issued in CA

Legal business name

PORTABLE DENTAL DIAGNOSTIC SERVICES

Practice address

10924 Daines Dr
Temple City, CA 91780-2920

Phone

(415) 279-5978

NPI assigned

May 7, 2014

Organization subpart

No

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

Authorized official

Name

Michelle Hyunaechang Meador, DMD

Title

Coe

Phone

(415) 279-5978

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399420800000",
    "number": "1356751630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10924 DAINES DR",
            "city": "TEMPLE CITY",
            "state": "CA",
            "postal_code": "917802920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10924 DAINES DR",
            "city": "TEMPLE CITY",
            "state": "CA",
            "postal_code": "917802920",
            "telephone_number": "415-279-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE DENTAL DIAGNOSTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-07",
        "last_updated": "2014-05-07",
        "status": "A",
        "authorized_official_last_name": "MEADOR",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "HYUNAECHANG",
        "authorized_official_title_or_position": "COE",
        "authorized_official_telephone_number": "415-279-5978",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Temple City, CA
• Providers in Temple City, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2014; 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.