Active NPI
Marisa Cristina Ludden, DDS
- Dentist
- Bonita, CA
National Provider Identifier
1548505803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61894
- Practice address
- 5050 Bonita Rd
Bonita, CA 91902 - Phone
- (619) 267-2115
- NPI assigned
- Nov 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61894 | CA | Primary |
Addresses
Primary practice location
5050 Bonita Rd
Bonita, CA 91902
Mailing address
5050 Bonita Rd
Bonita, CA 91902-1701
Phone (619) 267-2115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61894 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marisa Podesto DDS, Dental Corporation | Past | Accepting new patients | |
| Gregory Davis DDS Inc. | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Bonita Dental Center
- Dental Clinic/Center
- Bonita, CA
- NPI 1588171235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573516800000",
"number": "1548505803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5050 BONITA RD",
"city": "BONITA",
"state": "CA",
"postal_code": "919021701",
"telephone_number": "619-267-2115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5050 BONITA RD",
"city": "BONITA",
"state": "CA",
"postal_code": "91902",
"telephone_number": "619-267-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUDDEN",
"first_name": "MARISA",
"middle_name": "CRISTINA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-27",
"last_updated": "2019-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "61894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonita, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.