NPIMap

Organization Active NPI

Kids Community Clinic of Burbank

Doing business as Kids' Community Dental Clinic

  • Dentist
  • Burbank, CA
National Provider Identifier
1487056180
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE33337 Issued in CA
Legal business name
KIDS COMMUNITY CLINIC OF BURBANK
Doing business as
Kids' Community Dental Clinic
Practice address
400 W Elmwood Ave
Burbank, CA 91506-3304
Phone
(818) 841-8010
Fax
(818) 841-8006
NPI assigned
Sep 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2014

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

Authorized official

Name
Dr. Richard Marias, DMD
Title
Board President, Volunteer Dentist
Phone
(818) 841-8010

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DE33337 CA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 032653 CA
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X 27156 CA
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X 27544 CA
Dental AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 126800000X 77534 CA

Addresses

Primary practice location

400 W Elmwood Ave
Burbank, CA 91506-3304

Mailing address

400 W Elmwood Ave
Burbank, CA 91506-3304
Phone (818) 841-8010

Other names 1

  • Kids' Community Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1411516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411516800000",
    "number": "1487056180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W ELMWOOD AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915063304",
            "telephone_number": "818-841-8010",
            "fax_number": "818-841-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W ELMWOOD AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915063304",
            "telephone_number": "818-841-8010",
            "fax_number": "818-841-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS COMMUNITY CLINIC OF BURBANK",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-24",
        "last_updated": "2014-09-24",
        "status": "A",
        "authorized_official_last_name": "MARIAS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "BOARD PRESIDENT, VOLUNTEER DENTIST",
        "authorized_official_telephone_number": "818-841-8010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "DE33337",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "032653",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "27156",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "27544",
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "77534",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids' Community Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burbank, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2014; 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.