Active NPI
Dyanadewi Iskaq, DDS
- General Practice Dentistry
- Rancho Cucamonga, CA
National Provider Identifier
1659448736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 35914
- Practice address
- 11561 Foothill Blvd
Suite 104
Rancho Cucamonga, CA 91730-3997 - Phone
- (909) 483-7811
- NPI assigned
- Nov 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 35914 | CA | Primary |
Addresses
Primary practice location
11561 Foothill Blvd
Suite 104
Rancho Cucamonga, CA 91730-3997
Mailing address
PO Box 3430
Fullerton, CA 92834-3430
Phone (909) 483-7811
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150817003017 | CA | Order and Referring Only - Dentist | 6305151580 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35914 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659448736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3430",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928343430",
"telephone_number": "909-483-7811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11561 FOOTHILL BLVD",
"address_2": "SUITE 104",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303997",
"telephone_number": "909-483-7811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISKAQ",
"first_name": "DYANADEWI",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "35914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.