Active NPI
Olga Antipova
- General Practice Dentistry
- Santa Rosa, CA
National Provider Identifier
1396099115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 61522
- Practice address
- 140 Stony Point Rd Ste a
Santa Rosa, CA 95401-4121 - Phone
- (707) 578-3118
- NPI assigned
- Oct 31, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61522 | CA | Primary |
Addresses
Primary practice location
140 Stony Point Rd Ste a
Santa Rosa, CA 95401-4121
Mailing address
5380 Auburn Folsom Rd
Granite Bay, CA 95746-5895
Phone (916) 801-7977
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | DO NOT HAVE IT YET |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351641600000",
"number": "1396099115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5380 AUBURN FOLSOM RD",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957465895",
"telephone_number": "916-801-7977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 STONY POINT RD STE A",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954014121",
"telephone_number": "707-578-3118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTIPOVA",
"first_name": "OLGA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-31",
"last_updated": "2012-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "61522",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DO NOT HAVE IT YET",
"identifier": "NA",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.