Active NPI
Demetrio Tagulinao Sta. Ana Jr., D.D.S.
- Dentist
- Fresno, CA
National Provider Identifier
1487843710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 43250
- Practice address
- 3616 W Shaw Ave
Fresno, CA 93711-3231 - Phone
- (559) 277-0111
- Fax
- (559) 277-0133
- NPI assigned
- Oct 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 43250 | CA | Primary |
Addresses
Primary practice location
3616 W Shaw Ave
Fresno, CA 93711-3231
Mailing address
3616 W Shaw Ave
Fresno, CA 93711-3231
Phone (559) 277-0111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43250 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Demetrio Sta Ana Jr DDS Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Fresno, CA
- NPI 1952581282
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193097600000",
"number": "1487843710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3616 W SHAW AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113231",
"telephone_number": "559-277-0111",
"fax_number": "559-277-0133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3616 W SHAW AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113231",
"telephone_number": "559-277-0111",
"fax_number": "559-277-0133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STA. ANA",
"first_name": "DEMETRIO",
"middle_name": "TAGULINAO",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-23",
"last_updated": "2007-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "43250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.