NPIMap

Organization Active NPI

Western Dental Services, Inc.

  • General Practice Dentistry
  • Antioch, CA
National Provider Identifier
1659427771
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WESTERN DENTAL SERVICES, INC.
Practice address
2590 Sycamore Dr
Antioch, CA 94509-2909
Phone
(925) 776-1140
Fax
(925) 776-1148
NPI assigned
Jan 25, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Cindy E Avalos
Title
PPO Coordinator
Phone
(714) 480-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

2590 Sycamore Dr
Antioch, CA 94509-2909

Mailing address

2590 Sycamore Dr
Antioch, CA 94509-2909
Phone (925) 776-1140

Other identifiers 1

IdentifierTypeStateIssuer
G90179-64MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Western Dental Services Inc278 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2590 Sycamore Dr
Antioch, CA 94509
Phone (800) 579-3783

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659427771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2590 SYCAMORE DR",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945092909",
            "telephone_number": "925-776-1140",
            "fax_number": "925-776-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2590 SYCAMORE DR",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945092909",
            "telephone_number": "925-776-1140",
            "fax_number": "925-776-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN DENTAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AVALOS",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PPO COORDINATOR",
        "authorized_official_telephone_number": "714-480-3000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G90179-64",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.