Tennessee Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

License

40290 Issued in CA

Legal business name

TENNESSEE DENTAL CORPORATION

Practice address

414 Tennessee St
Redlands, CA 92373-8163

Phone

(909) 798-4000

NPI assigned

Apr 20, 2016

Last updated

Nov 13, 2016By 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

Epifania V NicolasNPI 1962661611

Title

Ceo

Phone

(714) 906-9116

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Epifania Viola Nicolas, DDS

  • Dentist
  • Anaheim, CA
  • NPI 1962661611
  Authorized official Same address or phone

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

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478995200000",
    "number": "1417301060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 TENNESSEE ST STE K1",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738152",
            "telephone_number": "909-798-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 TENNESSEE ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738163",
            "telephone_number": "909-798-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-20",
        "last_updated": "2016-11-13",
        "status": "A",
        "authorized_official_last_name": "NICOLAS",
        "authorized_official_first_name": "EPIFANIA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-906-9116"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "40290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B4029004",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lanier Parnell Taylor, D.D.S.
• Tanya L Taylor
• Timothy Michael Taylor, NP
• Lena Te, PHARM.D.
• Rebecca Becky Tekeian
• Melissa Ann Teoli, PA-C
• Terracina Surgical Arts Inc
• Alexander Terrazas, MD
• Christina Thaxton
• Ashlea Thayer, LVN

• Dentist in Redlands, CA
• Providers in Redlands, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2016; 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.