Individual provider Active NPI

Robert Edward Maroon, D.D.S.,F.I.C.O.I

  • General Practice Dentistry
  • Chula Vista, CA
National Provider Identifier
1407926801
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
43466 Issued in CA
Practice address
374 E H St
Suite 1710
Chula Vista, CA 91910-7484
Phone
(619) 691-0400
Fax
(619) 691-7783
NPI assigned
Nov 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 43466 CA Primary

Addresses

Primary practice location

374 E H St
Suite 1710
Chula Vista, CA 91910-7484

Mailing address

374 E H St
Suite 1710
Chula Vista, CA 91910-7484
Phone (619) 691-0400

Other names 1

  • Robert Edward Maroon Former name

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

State licenses

LicenseStateTypeSpecialty
43466CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ri Maroon Dental Group PC CurrentSince Sep 27, 2020 Accepting new patients
East Lake Family Dentistry General Practice Past Accepting new patients

Locations

1339 Third Ave
Chula Vista, CA 91911
Phone (619) 271-8682

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407926801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 E H ST",
            "address_2": "SUITE 1710",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919107484",
            "telephone_number": "619-691-0400",
            "fax_number": "619-691-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 E H ST",
            "address_2": "SUITE 1710",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919107484",
            "telephone_number": "619-691-0400",
            "fax_number": "619-691-7783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAROON",
        "first_name": "ROBERT",
        "middle_name": "EDWARD",
        "credential": "D.D.S.,F.I.C.O.I",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERT",
            "last_name": "MAROON",
            "middle_name": "EDWARD",
            "credential": "D.D.S.,F.I.C.O.I",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.