NPIMap

Organization Active NPI

Dr. Deza's Dental Office Inc.

  • Dental Clinic/Center
  • Moreno Valley, CA
National Provider Identifier
1548612856
Registry record updated Jul 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
43332 Issued in CA
Legal business name
DR. DEZA'S DENTAL OFFICE INC.
Practice address
23080 Alessandro Blvd Ste 201
Moreno Valley, CA 92553-9674
Phone
(951) 697-0909
Fax
(951) 697-1116
NPI assigned
Jul 11, 2016
Last updated
Jul 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2016

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

Authorized official

Name
Rocio Deza, D.D.SNPI 1982707907
Title
Dentist/Owner
Phone
(951) 697-0909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 43332 CA Primary

Addresses

Primary practice location

23080 Alessandro Blvd Ste 201
Moreno Valley, CA 92553-9674

Mailing address

23080 Alessandro Blvd Ste 201
Moreno Valley, CA 92553-9674
Phone (951) 697-0909

Other identifiers 1

IdentifierTypeStateIssuer
1982707907MedicaidCA

National Provider Directory

National Provider Directory

Locations

23080 Alessandro Blvd
Ste 201
Moreno Valley, CA 92553
Phone (951) 697-0909

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1548612856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23080 ALESSANDRO BLVD STE 201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539674",
            "telephone_number": "951-697-0909",
            "fax_number": "951-697-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23080 ALESSANDRO BLVD STE 201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539674",
            "telephone_number": "951-697-0909",
            "fax_number": "951-697-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. DEZA'S DENTAL OFFICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-11",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "DEZA",
        "authorized_official_first_name": "ROCIO",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "951-697-0909",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "43332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982707907",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; 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.