Specialty Dental Group

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SPECIALTY DENTAL GROUP

Practice address

1777 N Bellflower Blvd Ste 102
Long Beach, CA 90815-4019

Phone

(909) 948-7211

Fax

(909) 948-7213

NPI assigned

Mar 18, 2013

Organization subpart

No

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

Authorized official

Name

Jorge Osorio

Title

Partner

Phone

(909) 948-7213

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363564800000",
    "number": "1386986362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 N BELLFLOWER BLVD STE 102",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908154019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 N BELLFLOWER BLVD STE 102",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908154019",
            "telephone_number": "909-948-7211",
            "fax_number": "909-948-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-18",
        "last_updated": "2013-03-18",
        "status": "A",
        "authorized_official_last_name": "OSORIO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "909-948-7213"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; 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.