NPIMap

Organization Active NPI

Bennett Jeong, DDS, Inc.

Doing business as Via Verde Dental

  • Dental Clinic/Center
  • San Dimas, CA
National Provider Identifier
1366850778
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
63595 Issued in CA
Legal business name
BENNETT JEONG, DDS, INC.
Doing business as
Via Verde Dental
Practice address
1057 Via Verde
San Dimas, CA 91773-4347
Phone
(909) 599-8331
NPI assigned
Jul 29, 2014
Last updated
Jun 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
Dr. Bennett Jeong, DDSNPI 1700869039
Title
Owner
Phone
(909) 599-8331

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
Dental Clinic/Center 261QD0000X 63595 CA Primary

Addresses

Primary practice location

1057 Via Verde
San Dimas, CA 91773-4347

Mailing address

1057 Via Verde
San Dimas, CA 91773-4347
Phone (909) 599-8331

Other names 1

  • Via Verde Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1057 Via Verde
San Dimas, CA 91773
Phone (909) 599-8331

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": "1406592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1366850778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 VIA VERDE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917734347",
            "telephone_number": "909-599-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 VIA VERDE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917734347",
            "telephone_number": "909-599-8331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT JEONG, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-29",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "JEONG",
        "authorized_official_first_name": "BENNETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-599-8331",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "63595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Via Verde Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Via Verde Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.