Individual provider Active NPI

Liliana Popova, DDS

  • Pediatric Dentistry
  • Rialto, CA
National Provider Identifier
1487306536
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
109293 Issued in CA
Practice address
1205 Renaissance Pkwy Ste 240
Rialto, CA 92376-2418
Phone
(909) 746-5000
NPI assigned
Jan 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 109293 CA Primary

Addresses

Primary practice location

1205 Renaissance Pkwy Ste 240
Rialto, CA 92376-2418

Mailing address

27000 W Lugonia Ave Apt 4310
Redlands, CA 92374-2083
Phone (540) 522-9339

Other practice location 1

6655 Travis St Ste 460
Houston, TX 77030-1316
Phone (713) 500-8220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240524002379 CA Order and Referring Only - DentistPractitioner - Dentist 8123460953

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Health Science Center at Houston Pediatric Dentistry PastSince Jan 1, 2022 Accepting new patients
Ut Physicians PastSince Jan 1, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1487306536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27000 W LUGONIA AVE APT 4310",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742083",
            "telephone_number": "540-522-9339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 RENAISSANCE PKWY STE 240",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923762418",
            "telephone_number": "909-746-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6655 Travis St Ste 460",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301316",
            "country_code": "US",
            "telephone_number": "713-500-8220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POPOVA",
        "first_name": "LILIANA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-20",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "109293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rialto, CA

Sources for this page

Verify at the official NPI Registry.