Olivia Sugimoto, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

103966 Issued in CA

Practice address

5800 Santa Rosa Rd Ste 101
Camarillo, CA 93012-7060

Phone

(805) 987-8782

NPI assigned

Jul 14, 2019

Last updated

Jul 14, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Olivia Donaldson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Steven G. Johnson Dental Corporation

  dba Johnson Family Dental

  • General Practice Dentistry
  • Camarillo, CA
  • NPI 1770975492
  NPD (past)

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

{
    "created_epoch": "1563062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563062400000",
    "number": "1588216147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 MIKE LOZA DR UNIT 204",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930128493",
            "telephone_number": "805-766-3249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 SANTA ROSA RD STE 101",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930127060",
            "telephone_number": "805-987-8782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUGIMOTO",
        "first_name": "OLIVIA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-14",
        "last_updated": "2019-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "103966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLIVIA",
            "last_name": "DONALDSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kaci Stubblefield
• Matthew Stump
• Jacquelinne Sudaria, LMFT
• Roy Isao Sugasawara, MD
• Rebecca Sugawara, MPPD, RD
• Rita Helene Suley, OTR-L
• Karen Sullivan
• Kevin Sullivan
• Stephanie Sullivan
• Sarah Sundstrom

• General Practice Dentistry in Camarillo, CA
• Providers in Camarillo, 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 Jul 14, 2019; 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.