NPIMap

Organization Active NPI

Portola Dental Group

  • Preferred Provider Organization
  • Palm Desert, CA
National Provider Identifier
1396175071
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
51212 Issued in OK
Legal business name
PORTOLA DENTAL GROUP
Practice address
44853 Portola Avenue
Ste B
Palm Desert, CA 92260
Phone
(760) 346-1414
Fax
(760) 346-7335
NPI assigned
Nov 18, 2013
Last updated
Nov 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

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

Authorized official

Name
Marc Ernest Leblanc, DDSNPI 1396834362
Title
Dentist
Phone
(760) 346-1414

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 36169 CA
Preferred Provider Organization 305R00000X 51212 OK Primary

Addresses

Primary practice location

44853 Portola Avenue
Ste B
Palm Desert, CA 92260

Mailing address

44853 Portola Avenue
Ste B
Palm Desert, CA 92260
Phone (760) 346-1414

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1396175071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44853 PORTOLA AVENUE",
            "address_2": "STE B",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "92260",
            "telephone_number": "760-346-1414",
            "fax_number": "760-346-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44853 PORTOLA AVENUE",
            "address_2": "STE B",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "92260",
            "telephone_number": "760-346-1414",
            "fax_number": "760-346-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTOLA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "LEBLANC",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "ERNEST",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "760-346-1414",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "36169",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OK",
            "license": "51212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Desert, CA

Sources for this page

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