NPIMap

Organization Active NPI

Hidden Lake Dental Group, LLP

  • General Practice Dentistry
  • Irvine, CA
National Provider Identifier
1629472865
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HIDDEN LAKE DENTAL GROUP, LLP
Practice address
17000 Red Hill Ave
Irvine, CA 92614-5626
Phone
(303) 427-4001
Fax
(303) 427-4072
NPI assigned
Oct 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Authorized official

Name
Dr. Jessica B Peters, DDS
Title
Owner
Phone
(303) 427-4001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

17000 Red Hill Ave
Irvine, CA 92614-5626

Mailing address

7025 Sheridan Blvd
Suite 200
Westminster, CO 80003
Phone (303) 427-4001

Other names 1

  • Hidden Lake Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

7025 Sheridan Blvd
Ste 200
Westminster, CO 80003
Phone (303) 427-4001

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": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1629472865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7025 SHERIDAN BLVD",
            "address_2": "SUITE 200",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "80003",
            "telephone_number": "303-427-4001",
            "fax_number": "303-427-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "303-427-4001",
            "fax_number": "303-427-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN LAKE DENTAL GROUP, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-427-4001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hidden Lake Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; 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.