NPIMap

Organization Active NPI

Sycamore Family Dentistry

  • General Practice Dentistry
  • Hercules, CA
National Provider Identifier
1487969028
Registry record updated Aug 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
55619 Issued in CA
Legal business name
SYCAMORE FAMILY DENTISTRY
Practice address
1581 Sycamore Ave
Suite 3
Hercules, CA 94547-1700
Phone
(510) 799-2900
Fax
(510) 799-2902
NPI assigned
Aug 6, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2010

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

Authorized official

Name
Dr. Elmer Santos De Leon, DDS
Title
President/Ceo
Phone
(510) 799-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 55619 CA Primary

Addresses

Primary practice location

1581 Sycamore Ave
Suite 3
Hercules, CA 94547-1700

Mailing address

1581 Sycamore Ave
Suite 3
Hercules, CA 94547-1700
Phone (510) 799-2900

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281052800000",
    "number": "1487969028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1581 SYCAMORE AVE",
            "address_2": "SUITE 3",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945471700",
            "telephone_number": "510-799-2900",
            "fax_number": "510-799-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1581 SYCAMORE AVE",
            "address_2": "SUITE 3",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945471700",
            "telephone_number": "510-799-2900",
            "fax_number": "510-799-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYCAMORE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-06",
        "last_updated": "2010-08-06",
        "status": "A",
        "authorized_official_last_name": "DE LEON",
        "authorized_official_first_name": "ELMER",
        "authorized_official_middle_name": "SANTOS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "510-799-2900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hercules, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; 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.