Crown Concordia Dental Network

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

44169 Issued in CA

Legal business name

CROWN CONCORDIA DENTAL NETWORK

Practice address

290 W Orange Show Rd
Suite 105
San Bernardino, CA 92408-3345

Phone

(909) 885-7600

Fax

(909) 885-7612

NPI assigned

Oct 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wagner De Luca Faria, DDS

Title

President

Phone

(909) 885-7600

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1427237577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 W ORANGE SHOW RD",
            "address_2": "SUITE 105",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083345",
            "telephone_number": "909-885-7600",
            "fax_number": "909-885-7612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 W ORANGE SHOW RD",
            "address_2": "SUITE 105",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083345",
            "telephone_number": "909-885-7600",
            "fax_number": "909-885-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN CONCORDIA DENTAL NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "FARIA",
        "authorized_official_first_name": "WAGNER",
        "authorized_official_middle_name": "DE LUCA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-885-7600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "44169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reginald Crosby, RADI
• Niana L. Cross
• Rosemarie Cross
• Crossover Health Medical Group (Crossover @ San Bernardino)
• Crown City Medical Group
• Eugene Crowther
• Zitlaly Lizeth Cruz-Roman
• Bernard Nunez Cruz
• Chrystal Mye Cruz
• Jessica Cruz

• Health Maintenance Organization in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.