NPIMap

Organization Active NPI

Weideman-Tse Dental Corporation

Doing business as Smile Island Pediatric & Adult Dental Group

  • Pediatric Dentistry
  • Rocklin, CA
National Provider Identifier
1548413289
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
37753 Issued in CA
Legal business name
WEIDEMAN-TSE DENTAL CORPORATION
Doing business as
Smile Island Pediatric & Adult Dental Group
Practice address
6522 Lonetree Blvd
Rocklin, CA 95765-5874
Phone
(916) 773-6565
Fax
(916) 773-6510
NPI assigned
Oct 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Authorized official

Name
Dr. Kelvin A Tse, DDS
Title
Owner
Phone
(916) 773-6565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 37975 CA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 37753 CA Primary

Addresses

Primary practice location

6522 Lonetree Blvd
Rocklin, CA 95765-5874

Mailing address

6522 Lonetree Blvd
Rocklin, CA 95765-5874
Phone (916) 773-6565

Other names 1

  • Smile Island Pediatric & Adult Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

6522 Lonetree Blvd
Rocklin, CA 95765
Phone (916) 773-6565

Practitioners & affiliated clinicians

Practitioners 4

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": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1548413289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6522 LONETREE BLVD",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957655874",
            "telephone_number": "916-773-6565",
            "fax_number": "916-773-6510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6522 LONETREE BLVD",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957655874",
            "telephone_number": "916-773-6565",
            "fax_number": "916-773-6510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEIDEMAN-TSE DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "TSE",
        "authorized_official_first_name": "KELVIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-773-6565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "37975",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "37753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Island Pediatric & Adult Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocklin, CA

Sources for this page

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