NPIMap

Organization Active NPI

David R. Wyndhamsmith, a Professional Dental Corporation

  • Endodontics
  • Pasadena, CA
National Provider Identifier
1508088675
Registry record updated Oct 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
46195 Issued in CA
Legal business name
DAVID R. WYNDHAMSMITH, A PROFESSIONAL DENTAL CORPORATION
Practice address
1092 E Green St
Pasadena, CA 91106-2506
Phone
(626) 395-5140
Fax
(626) 395-5144
NPI assigned
May 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2015

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

Authorized official

Name
Mrs. Patrice A Wyndhamsmith
Title
Office Manager
Phone
(626) 795-9328

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X 46195 CA Primary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 41122 CA
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 49312 CA
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 37519 CA

Addresses

Primary practice location

1092 E Green St
Pasadena, CA 91106-2506

Mailing address

1092 E Green St
Pasadena, CA 91106-2506
Phone (626) 395-5140

Other names 1

  • Pasadena Medical/Dental Specialist Doing business as

National Provider Directory

National Provider Directory
Tax ID family
David R Wyndhamsmith a Professional Dental Corporation2 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

1092 E Green St
Pasadena, CA 91106
Phone (626) 395-5140

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444867200000",
    "number": "1508088675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1092 E GREEN ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911062506",
            "telephone_number": "626-395-5140",
            "fax_number": "626-395-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1092 E GREEN ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911062506",
            "telephone_number": "626-395-5140",
            "fax_number": "626-395-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID R. WYNDHAMSMITH, A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2015-10-15",
        "status": "A",
        "authorized_official_last_name": "WYNDHAMSMITH",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "626-795-9328",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "46195",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "41122",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "49312",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "37519",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pasadena Medical/Dental Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; 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.