NPIMap

Organization Active NPI

Gonzalez Professional Dental Corporation

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1558489849
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
46260 Issued in CA
Legal business name
GONZALEZ PROFESSIONAL DENTAL CORPORATION
Practice address
2010 Wilshire Blvd
Ste.# 512
Los Angeles, CA 90057-3507
Phone
(213) 413-1283
Fax
(213) 413-0982
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Aleli Escalante Gonzalez, D.D.S.
Title
D.D.S.
Phone
(213) 413-1283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 46260 CA Primary

Addresses

Primary practice location

2010 Wilshire Blvd
Ste.# 512
Los Angeles, CA 90057-3507

Mailing address

2010 Wilshire Blvd
Ste.# 512
Los Angeles, CA 90057-3507
Phone (213) 413-1283

Other identifiers 1

IdentifierTypeStateIssuer
G94018-01OtherCAMEDI-CAL PROVIDER NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Gonzalez 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

2010 Wilshire Blvd
Ste 512
Los Angeles, CA 90057
Phone (213) 413-1283

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558489849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 WILSHIRE BLVD",
            "address_2": "STE.# 512",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573507",
            "telephone_number": "213-413-1283",
            "fax_number": "213-413-0982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 WILSHIRE BLVD",
            "address_2": "STE.# 512",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573507",
            "telephone_number": "213-413-1283",
            "fax_number": "213-413-0982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GONZALEZ PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ALELI",
        "authorized_official_middle_name": "ESCALANTE",
        "authorized_official_title_or_position": "D.D.S.",
        "authorized_official_telephone_number": "213-413-1283",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "46260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER NUMBER",
            "identifier": "G94018-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • 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.