Jessica Abrenio Bautista, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

56783 Issued in CA

Practice address

2094 W Redlands Blvd
Suite F
Redlands, CA 92373-6221

Phone

(909) 335-0500

NPI assigned

Apr 15, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 10, 2017 through Jan 10, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251158400000",
    "number": "1396919973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18590 VAN BUREN BLVD",
            "address_2": "SUITE 2-B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925089109",
            "telephone_number": "951-776-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2094 W REDLANDS BLVD",
            "address_2": "SUITE F",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923736221",
            "telephone_number": "909-335-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "JESSICA",
        "middle_name": "ABRENIO",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-15",
        "last_updated": "2009-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Giv Bateni, M.D.
• Sharita R Bates
• Kristin Batla, PA-C
• Jessica A Batterson, MSN, RN, FNP-BC
• Devon Nicole Baumbach, CCC-SLP
• Dominique Bazanos, LIFESTYLE COACH
• Julie Bazzo, PSYD
• Kristen Beall
• Allison Beard
• Pat M Beaupre, PHD

• General Practice Dentistry in Redlands, CA
• Providers in Redlands, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.