Peninsula Pediatric Dental Practice

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

61391 Issued in CA

Legal business name

PENINSULA PEDIATRIC DENTAL PRACTICE

Practice address

50 S San Mateo Dr Ste 160
San Mateo, CA 94401-3859

Phone

(650) 375-8300

Fax

(650) 375-8130

NPI assigned

Jan 2, 2014

Last updated

Jan 2, 2014By 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

Jan Murray

Title

Office Manager

Phone

(650) 375-8300

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyler Davis, DMD

  • Pediatric Dentistry
  • San Mateo, CA
  • NPI 1790096154
  NPD (past)
• Bradley Smith, D.M.D.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • San Mateo, CA
  • NPI 1023412921
  NPD (past)

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388620800000",
    "number": "1639590003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR STE 160",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013859",
            "telephone_number": "650-375-8300",
            "fax_number": "650-375-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR STE 160",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013859",
            "telephone_number": "650-375-8300",
            "fax_number": "650-375-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PEDIATRIC DENTAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2014-01-02",
        "status": "A",
        "authorized_official_last_name": "MURRAY",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "650-375-8300"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "22673",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "61391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "1386792919",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL INSURANCE CARRIER",
            "identifier": "1386792919",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peninsula Health Care District
• Peninsula Medical Associates
• Peninsula Nephrology, Inc. (San Mateo Dialysis Center)
• Peninsula Nephrology, Inc. (South San Francisco Dialysis Center)
• Peninsula OBGYN Integrative
• Peninsula Pediatric Med GRP Inc
• Peninsula Spine & Sports Rehab, a Rommel Hindocha Chiropractic Corp.
• Peninsula Spine Education &Treatment Center
• Peninsula Ultrasound, Mammography & Radiology Services Medical Group
• Peninsula Ultrasound, Mammography and Radiology Services Med Group Inc (Peninsula Diagnostic Imaging Inc)

• Pediatric Dentistry in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.