NPIMap

Organization Active NPI

Southridge Dental Group

  • Dentist
  • Fontana, CA
National Provider Identifier
1497924997
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
24452 Issued in CA
Legal business name
SOUTHRIDGE DENTAL GROUP
Practice address
14050 Cherry Ave
Ste. a
Fontana, CA 92337-0766
Phone
(909) 822-9090
Fax
(909) 822-9094
NPI assigned
Feb 28, 2008
Last updated
Feb 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Authorized official

Name
Mr. Howard GlassmanNPI 1407051295
Title
Dentist
Phone
(909) 822-9090

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 24452 CA Primary

Addresses

Primary practice location

14050 Cherry Ave
Ste. a
Fontana, CA 92337-0766

Mailing address

14050 Cherry Ave
Ste. a
Fontana, CA 92337-0766
Phone (909) 822-9090

National Provider Directory

National Provider Directory
Tax ID family
Phillips Ranch Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

14050 Cherry Ave
Ste A
Fontana, CA 92337
Phone (909) 280-4742

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": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1497924997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 CHERRY AVE",
            "address_2": "STE. A",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923370766",
            "telephone_number": "909-822-9090",
            "fax_number": "909-822-9094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14050 CHERRY AVE",
            "address_2": "STE. A",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923370766",
            "telephone_number": "909-822-9090",
            "fax_number": "909-822-9094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHRIDGE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "GLASSMAN",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "909-822-9090",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "24452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.