Individual provider Active NPI

Martha Veronica Saucedo, D.D.S.

  • General Practice Dentistry
  • Upland, CA
National Provider Identifier
1649478769
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
42949 Issued in CA
Practice address
1150 N Mountain Ave
113
Upland, CA 91786-3668
Phone
(909) 981-9595
Fax
(909) 981-9550
NPI assigned
Jul 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 42949 CA Primary

Addresses

Primary practice location

1150 N Mountain Ave
113
Upland, CA 91786-3668

Mailing address

1150 N Mountain Ave
113
Upland, CA 91786-3668
Phone (909) 981-9595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160714001930 CA Order and Referring Only - DentistPractitioner - Dentist 1951693712

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
42949CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1649478769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 N MOUNTAIN AVE",
            "address_2": "113",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863668",
            "telephone_number": "909-981-9595",
            "fax_number": "909-981-9550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N MOUNTAIN AVE",
            "address_2": "113",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863668",
            "telephone_number": "909-981-9595",
            "fax_number": "909-981-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAUCEDO",
        "first_name": "MARTHA",
        "middle_name": "VERONICA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.