NPIMap

Organization Active NPI

Walter Jefferson Dental Corporation

  • General Practice Dentistry
  • Harbor City, CA
National Provider Identifier
1437700952
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WALTER JEFFERSON DENTAL CORPORATION
Practice address
962 Sepulveda Blvd
Harbor City, CA 90710-1405
Phone
(310) 539-3245
NPI assigned
Sep 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Authorized official

Name
Walter Jefferson, DDS
Title
Owner
Phone
(310) 539-3245

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

962 Sepulveda Blvd
Harbor City, CA 90710-1405

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Harbor City Modern Dentistry Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

962 Sepulveda Blvd
Harbor City, CA 90710
Phone (310) 539-3245

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1437700952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "962 SEPULVEDA BLVD",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907101405",
            "telephone_number": "310-539-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER JEFFERSON DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-25",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-539-3245",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor City Modern Dentistry Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harbor City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.