Active NPI
Gloria Estela Villasenor Fass, DDS
- Dentist
- Modesto, CA
National Provider Identifier
1376639567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 48403
- Practice address
- 140 McHenry Ave Ste 5
Modesto, CA 95354-0568 - Phone
- (209) 526-9188
- Fax
- (209) 409-8608
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 48403 | CA | Primary |
Addresses
Primary practice location
140 McHenry Ave Ste 5
Modesto, CA 95354-0568
Mailing address
140 McHenry Ave Ste 5
Modesto, CA 95354-0568
Phone (209) 526-9188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48403 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652140800000",
"number": "1376639567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 MCHENRY AVE STE 5",
"city": "MODESTO",
"state": "CA",
"postal_code": "953540568",
"telephone_number": "209-526-9188",
"fax_number": "209-409-8608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 MCHENRY AVE STE 5",
"city": "MODESTO",
"state": "CA",
"postal_code": "953540568",
"telephone_number": "209-526-9188",
"fax_number": "209-409-8608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLASENOR FASS",
"first_name": "GLORIA",
"middle_name": "ESTELA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2022-05-10",
"certification_date": "2022-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "48403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.