San Fernando Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

24826 Issued in CA

Legal business name

SAN FERNANDO DENTAL CENTER

Doing business as

Dr Jerry B Malleus

Practice address

125 S Brand Blvd
San Fernando, CA 91340-3304

Phone

(818) 365-6321

Fax

(818) 365-0011

NPI assigned

Feb 18, 2010

Last updated

Feb 18, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Larry E Ferguson

Title

Business Manager

Phone

(818) 365-6321

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr Jerry B Malleus Doing business as

Tax ID family

Dr Jerry B Malleus2 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.

• Jerry B Malleus, DDS Inc.

  • Dentist
  • San Fernando, CA
  • NPI 1922498302
  NPD tax ID

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1568784569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S BRAND BLVD",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913403304",
            "telephone_number": "818-365-6321",
            "fax_number": "818-365-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S BRAND BLVD",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913403304",
            "telephone_number": "818-365-6321",
            "fax_number": "818-365-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN FERNANDO DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "818-365-6321",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "24826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF DENTAL EXAMINERS",
            "identifier": "24826",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Jerry B Malleus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Francisco Salvagno
• Christojohn Samuel, MD
• San Fernando Community Health Center
• San Fernando Community Hospital (San Fernando Community Health Center)
• San Fernando Dental Care
• San Fernando Diagnostic and Imaging, Inc
• San Fernando Pharmacy Incorporated
• San Fernando Recovery Center
• San Fernando Recovery Center
• San Fernando Valley Community Mental Health Center, Inc. (San Fernando Valley CMHC Family Links)

• General Practice Dentistry in San Fernando, CA
• Providers in San Fernando, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; 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.