Matthew Enns, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

101260 Issued in CA

Practice address

30406 Haun Rd
Ste 740
Menifee, CA 92584-6816

Phone

(951) 679-4624

Fax

(951) 679-2221

NPI assigned

Jul 2, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Carolyn Ghazal and Minh Pham Dental Corporation

  • General Practice Dentistry
  • Menifee, CA
  • NPI 1619121241
  NPD (past)

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493251200000",
    "number": "1386027704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30406 HAUN RD",
            "address_2": "STE 740",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925846816",
            "telephone_number": "951-679-4624",
            "fax_number": "951-679-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30406 HAUN RD",
            "address_2": "STE 740",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925846816",
            "telephone_number": "951-679-4624",
            "fax_number": "951-679-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNS",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-02",
        "last_updated": "2017-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856836",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Embodied Wellness Foundation
• Richard Enriquez
• Paola Esparza
• Aleka Estrada, DPT
• Alondra Juana Estrada
• Angelica Lizbeth Estrada

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.