NPIMap

Organization Active NPI

A Professional Dental Corp.

  • Periodontics
  • Antioch, CA
National Provider Identifier
1639174279
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
40072 Issued in CA
Legal business name
A PROFESSIONAL DENTAL CORP.
Practice address
3505 Lone Tree Way
Ste 7
Antioch, CA 94509-6067
Phone
(925) 756-7884
Fax
(925) 756-7894
NPI assigned
Jun 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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

Authorized official

Name
Mrs. Kelly Ann Butti
Title
Office Manager
Phone
(925) 756-7884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 40072 CA Primary

Addresses

Primary practice location

3505 Lone Tree Way
Ste 7
Antioch, CA 94509-6067

Mailing address

3505 Lone Tree Way
Ste 7
Antioch, CA 94509-6067
Phone (925) 756-7884

Other names 1

  • A Nancy Drumov - Dubuk, DDS Former legal business name

National Provider Directory

National Provider Directory

Locations

3505 Lone Tree Way
Ste 7
Antioch, CA 94509
Phone (925) 756-7884

Practitioners & affiliated clinicians

Practitioners 1

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": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1639174279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 LONE TREE WAY",
            "address_2": "STE 7",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096067",
            "telephone_number": "925-756-7884",
            "fax_number": "925-756-7894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 LONE TREE WAY",
            "address_2": "STE 7",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096067",
            "telephone_number": "925-756-7884",
            "fax_number": "925-756-7894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A PROFESSIONAL DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "BUTTI",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "925-756-7884",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "40072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Nancy Drumov - Dubuk, DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Antioch, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.