NPIMap

Organization Active NPI

Clinica Dental Integral

  • General Practice Dentistry
  • Ontario, CA
National Provider Identifier
1457503922
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
MX15793 Issued in ZZ
Legal business name
CLINICA DENTAL INTEGRAL
Practice address
3045 S Archibald Ave
Suite H-289
Ontario, CA 91761-9001
Phone
(909) 758-8275
NPI assigned
Oct 16, 2008
Last updated
Oct 16, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
AMEXUS DENTAL PPOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

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

Authorized official

Name
Jessica SerranoNPI 1235364241
Title
Administrator
Phone
(619) 270-2243

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X MX15793 ZZ Primary

Addresses

Primary practice location

3045 S Archibald Ave
Suite H-289
Ontario, CA 91761-9001

Mailing address

9379 Ignacio Comonfort
Suite 'B'
Tijuana, BAJA CALIFORNIA 22210
MX
Phone (619) 270-2243

National Provider Directory

National Provider Directory
Tax ID family
Clinica Dental Integral4 organizations share this tax ID, including this one
Part of
Clinica Dental Integral

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1457503922",
    "addresses": [
        {
            "country_code": "MX",
            "country_name": "Mexico",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "9379 IGNACIO COMONFORT",
            "address_2": "SUITE 'B'",
            "city": "TIJUANA",
            "state": "BAJA CALIFORNIA",
            "postal_code": "22210",
            "telephone_number": "619-270-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 S ARCHIBALD AVE",
            "address_2": "SUITE H-289",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917619001",
            "telephone_number": "909-758-8275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA DENTAL INTEGRAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMEXUS DENTAL PPO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "SERRANO",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "619-270-2243"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ZZ",
            "license": "MX15793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.