East Lake Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

43466 Issued in CA

Legal business name

EAST LAKE FAMILY DENTISTRY

Practice address

970 Eastlake Pkwy
Suite 103
Chula Vista, CA 91914-3561

Phone

(619) 482-2920

Fax

(619) 482-2924

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Robert E Maroon, D.D.S.,F.I.C.O.INPI 1407926801

Title

DDS

Phone

(619) 482-2920

Specialties & licenses 1

Addresses

Other names 1

• Robert EMaroon Other name

Locations

Practitioners 3

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

• Robert Edward Maroon, D.D.S.,F.I.C.O.I

  • General Practice Dentistry
  • Chula Vista, CA
  • NPI 1407926801
  NPD (past) Authorized official
• Ileana Dominique Maroon, DDS

  • Dentist
  • Chula Vista, CA
  • NPI 1861317745
  NPD (past)
• Ileana P Maroon, D.D.S

  • Dentist
  • Chula Vista, CA
  • NPI 1740649649
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508912858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 EASTLAKE PKWY",
            "address_2": "SUITE 103",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919143561",
            "telephone_number": "619-482-2920",
            "fax_number": "619-482-2924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 EASTLAKE PKWY",
            "address_2": "SUITE 103",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919143561",
            "telephone_number": "619-482-2920",
            "fax_number": "619-482-2924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LAKE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAROON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "619-482-2920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.,F.I.C.O.I"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Robert EMaroon",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• E L Racek MD Facs Inc
• Howard Glenn Eagle, D.D.S.
• Eagles Wings Home Care Inc.
• Trevor Michael Earl, PA-C
• Early Connections Therapy, Inc
• East Lake Medical, LLC
• Eastlake Family Medical Inc.
• Eastlake Laser Eye Associates
• Eastlake Optometry Inc.
• Eastlake Sleep Center

• General Practice Dentistry in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.