Eastshore Pediatric Dental Group

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

55811 Issued in CA

Legal business name

EASTSHORE PEDIATRIC DENTAL GROUP

Practice address

2000 Appian Way Ste 303
Pinole, CA 94564-2525

Phone

(510) 964-0168

NPI assigned

Jan 4, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Teri L Kim, DDS

Title

Co-Owner

Phone

(916) 792-9267

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325635200000",
    "number": "1437429669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 APPIAN WAY STE 303",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 APPIAN WAY STE 303",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642525",
            "telephone_number": "510-964-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSHORE PEDIATRIC DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-04",
        "last_updated": "2012-01-04",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "916-792-9267",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "55811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Pinole, CA
• Providers in Pinole, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; 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.