Gary and Mary West Senior Dental Center, Inc.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

55692 Issued in CA

Legal business name

GARY AND MARY WEST SENIOR DENTAL CENTER, INC.

Practice address

1525 4TH Ave
San Diego, CA 92101-3107

Phone

(760) 602-5862

NPI assigned

Aug 11, 2015

Last updated

Aug 11, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Karen Becerra, DDS, MPH

Title

President and Dentist

Phone

(760) 602-5862

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1396111530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013107",
            "telephone_number": "760-602-5862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013107",
            "telephone_number": "760-602-5862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY AND MARY WEST SENIOR DENTAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-11",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "BECERRA",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "PRESIDENT AND DENTIST",
        "authorized_official_telephone_number": "760-602-5862",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MPH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "55692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL DENTAL PROVIDER NPI",
            "identifier": "1740451012",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; 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.