NPIMap

Organization Active NPI

Dental Practice of DRS. McKelvey & Grossman, a Prof. Dental Corp.

  • General Practice Dentistry
  • Twain Harte, CA
National Provider Identifier
1578885141
Registry record updated Feb 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PRACTICE OF DRS. MCKELVEY & GROSSMAN, A PROF. DENTAL CORP.
Doing business as
Twain Harte Family Dental Care
Practice address
22629 Twain Harte Dr
Twain Harte, CA 95383-9405
Phone
(209) 586-2772
NPI assigned
Feb 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2010

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

Authorized official

Name
Dr. Phillip GrossmanNPI 1770697831
Title
DDS
Phone
(209) 586-2772

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

22629 Twain Harte Dr
Twain Harte, CA 95383-9405

Mailing address

22629 Twain Harte Dr
Twain Harte, CA 95383-9405
Phone (209) 586-2772

Other names 1

  • Twain Harte Family Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

22629 Twain Harte Dr
Twain Harte, CA 95383
Phone (209) 586-2772

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266883200000",
    "number": "1578885141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22629 TWAIN HARTE DR",
            "city": "TWAIN HARTE",
            "state": "CA",
            "postal_code": "953839405",
            "telephone_number": "209-586-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22629 TWAIN HARTE DR",
            "city": "TWAIN HARTE",
            "state": "CA",
            "postal_code": "953839405",
            "telephone_number": "209-586-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PRACTICE OF DRS. MCKELVEY & GROSSMAN, A PROF. DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-23",
        "last_updated": "2010-02-23",
        "status": "A",
        "authorized_official_last_name": "GROSSMAN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "209-586-2772",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twain Harte Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Twain Harte, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.