Individual provider Active NPI

Dunya Antwan, DDS

  • Dentist
  • Vista, CA
National Provider Identifier
1659580710
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
55683 Issued in CA
Practice address
520 W Vista Way
Vista, CA 92083-5704
Phone
(760) 941-1906
Fax
(760) 941-1906
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 55683 CA Primary

Addresses

Primary practice location

520 W Vista Way
Vista, CA 92083-5704

Mailing address

520 W. Vista Way
Vista, CA 92083
Phone (760) 941-1906

Other practice location 1

10450 Friars Rd
suite g
San Diego, CA 92120-2311
Phone (619) 640-5100

Other identifiers 1

IdentifierTypeStateIssuer
D55683MedicaidCA

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
I20150730010672 CA Order and Referring Only - DentistPractitioner - Dentist 5496069841

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
55683CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dunya G Antwan DDS Inc, Dentist Past Accepting new patients
Dunya Antwan DDS Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1659580710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W. VISTA WAY",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "92083",
            "telephone_number": "760-941-1906",
            "fax_number": "760-941-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W VISTA WAY",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920835704",
            "telephone_number": "760-941-1906",
            "fax_number": "760-941-1906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10450 Friars Rd",
            "address_2": "suite g",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921202311",
            "country_code": "US",
            "telephone_number": "619-640-5100",
            "fax_number": "619-640-5101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTWAN",
        "first_name": "DUNYA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "55683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D55683",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.