Individual provider Active NPI

David Christopher Flamenco, D.D.S.

  • Dentist
  • La Mesa, CA
National Provider Identifier
1366715807
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
61171 Issued in CA
Practice address
8860 Center Dr Ste 410
La Mesa, CA 91942-7003
Phone
(619) 493-2103
Fax
(619) 493-2212
NPI assigned
Feb 14, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61171 CA Primary

Addresses

Primary practice location

8860 Center Dr Ste 410
La Mesa, CA 91942-7003

Mailing address

8860 Center Dr Ste 410
La Mesa, CA 91942-7003
Phone (619) 493-2013

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191016002089 CA Practitioner - Dentist 4880996255 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61171CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kotha Flamenco Dental Corporation CurrentSince Mar 8, 2018 Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Jul 22, 2019 Accepting new patients

Locations

8860 Center Dr
Ste 410
La Mesa, CA 91942
Phone (619) 493-2103

5555 Grossmont Center Dr
La Mesa, CA 91942
Phone (619) 465-0711

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1366715807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8860 CENTER DR STE 410",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919427003",
            "telephone_number": "619-493-2013",
            "fax_number": "619-493-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8860 CENTER DR STE 410",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919427003",
            "telephone_number": "619-493-2103",
            "fax_number": "619-493-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAMENCO",
        "first_name": "DAVID",
        "middle_name": "CHRISTOPHER",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-14",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.