NPIMap

Organization Active NPI

George R Braithwaite

  • General Practice Dentistry
  • Vista, CA
National Provider Identifier
1508053323
Registry record updated Jul 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
24937 Issued in CA
Legal business name
GEORGE R BRAITHWAITE
Practice address
630 Alta Vista Dr
#108
Vista, CA 92084-5504
Phone
(760) 724-6537
Fax
(760) 724-5115
NPI assigned
Sep 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2011

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

Authorized official

Name
Dr. George R Braithwaite, D.M.D
Title
Dentist/President
Phone
(760) 724-6537

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 24937 CA Primary

Addresses

Primary practice location

630 Alta Vista Dr
#108
Vista, CA 92084-5504

Mailing address

630 Alta Vista Dr
#108
Vista, CA 92084-5504
Phone (760) 724-6537

Other names 1

  • FAMILY DENTAL Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311724800000",
    "number": "1508053323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ALTA VISTA DR",
            "address_2": "#108",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845504",
            "telephone_number": "760-724-6537",
            "fax_number": "760-724-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ALTA VISTA DR",
            "address_2": "#108",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845504",
            "telephone_number": "760-724-6537",
            "fax_number": "760-724-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE R BRAITHWAITE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2011-07-27",
        "status": "A",
        "authorized_official_last_name": "BRAITHWAITE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "760-724-6537",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "24937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY DENTAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; 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.