NPIMap

Organization Active NPI

Cheryl G. Vicencio, DMD, a Professional Corporation

Doing business as Vicencio Dental Group

  • Dentist
  • San Jose, CA
National Provider Identifier
1386058857
Registry record updated Jun 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
39908 Issued in CA
Legal business name
CHERYL G. VICENCIO, DMD, A PROFESSIONAL CORPORATION
Doing business as
Vicencio Dental Group
Practice address
753 Saratoga Ave
San Jose, CA 95129-2330
Phone
(408) 255-2222
Fax
(408) 255-2280
NPI assigned
Jun 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2014

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

Authorized official

Name
Dr. Cheryl G. Vicencio, DMDNPI 1124198296
Title
Owner/President
Phone
(408) 255-2222

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 39908 CA Primary

Addresses

Primary practice location

753 Saratoga Ave
San Jose, CA 95129-2330

Mailing address

753 Saratoga Ave
San Jose, CA 95129-2330
Phone (408) 255-2222

Other identifiers 1

IdentifierTypeStateIssuer
B39908OtherCAMEDI-CAL/DENTI-CAL

Other names 1

  • Vicencio Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

753 Saratoga Ave
San Jose, CA 95129
Phone (408) 255-2222

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1386058857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "753 SARATOGA AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951292330",
            "telephone_number": "408-255-2222",
            "fax_number": "408-255-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "753 SARATOGA AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951292330",
            "telephone_number": "408-255-2222",
            "fax_number": "408-255-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERYL G. VICENCIO, DMD, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-12",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "VICENCIO",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "408-255-2222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "39908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL/DENTI-CAL",
            "identifier": "B39908",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vicencio Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.