McCormack Dental Imaging

Primary specialty

Dental LaboratoryTaxonomy code 292200000X

License

RHP00053519 Issued in CA

Legal business name

MCCORMACK DENTAL IMAGING

Practice address

8860 Center Dr
Ste. 340
La Mesa, CA 91942-3068

Phone

(619) 461-3910

NPI assigned

Oct 22, 2015

Last updated

Oct 22, 2015By 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. Jerome N. Peck, DLXT

Title

Ceo

Phone

(415) 421-1389

Specialties & licenses 1

Addresses

Tax ID family

McCormack Dental Imaging2 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.

• McCormack Dental Imaging

  • Dental Laboratory
  • San Diego, CA
  • NPI 1689045718
  NPD tax ID

Locations

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445472000000",
    "number": "1598137184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 SUTTER ST",
            "address_2": "STE. 1542",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941084206",
            "telephone_number": "415-421-1389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8860 CENTER DR",
            "address_2": "STE. 340",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423068",
            "telephone_number": "619-461-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCORMACK DENTAL IMAGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-22",
        "last_updated": "2015-10-22",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-421-1389",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DLXT"
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "CA",
            "license": "RHP00053519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Lynn McCawley-Self
• Kathryn A McClane
• Gwendolyn Y McCleod
• Paul McClure
• Philip McClure Jr., R.N
• Julia P McCormick, MFT
• Rita K. McCrerey, LCSW
• McDowell Family Chiropractic, Inc.
• Gary Michael McDowell, DC, CCSP, QME
• Morgan Brian McElwee-Duhamel

• Dental Laboratory in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Dental Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; 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.