NPIMap

Organization Active NPI

Mouchamel Dental Corporation

  • Dentist
  • Burbank, CA
National Provider Identifier
1568645216
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
40861 Issued in CA
Legal business name
MOUCHAMEL DENTAL CORPORATION
Practice address
1319 N San Fernando Blvd
Burbank, CA 91504
Phone
(818) 557-2299
Fax
(818) 557-8749
NPI assigned
Dec 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Authorized official

Name
Dr. Sam Mouchamel, DDSNPI 1508081449
Title
Owner
Phone
(818) 557-2299

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 40861 CA Primary

Addresses

Primary practice location

1319 N San Fernando Blvd
Burbank, CA 91504

Mailing address

1319 N San Fernando Blvd
Burbank, CA 91504
Phone (818) 557-2299

Other identifiers 1

IdentifierTypeStateIssuer
G9109701OtherCADENTICAL

Other names 1

  • ABC Dental Group Other name

National Provider Directory

National Provider Directory

Locations

1319 N San Fernando Blvd
Burbank, CA 91504
Phone (818) 557-2299

Practitioners & affiliated clinicians

Practitioners 3

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": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1568645216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 N SAN FERNANDO BLVD",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "91504",
            "telephone_number": "818-557-2299",
            "fax_number": "818-557-8749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 N SAN FERNANDO BLVD",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "91504",
            "telephone_number": "818-557-2299",
            "fax_number": "818-557-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUCHAMEL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A",
        "authorized_official_last_name": "MOUCHAMEL",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-557-2299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "40861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "G9109701",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ABC Dental Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burbank, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.