Wildwood Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

51084 Issued in CA

Legal business name

WILDWOOD DENTAL GROUP

Practice address

3972 N Waterman Ave
San Bernardino, CA 92404-1700

Phone

(909) 886-4864

NPI assigned

Mar 20, 2014

Organization subpart

No

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

Authorized official

Name

Irene M Justin, DDS INC

Title

President

Phone

(909) 886-4864

Specialties & licenses 1

Addresses

Tax ID family

Irene M Justin Wildwood Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Irene M Justin Wildwood Dental Group

  • General Practice Dentistry
  • San Bernardino, CA
  • NPI 1689900870
  NPD tax ID

Locations

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1659798262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2413 S GROVE AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917616225",
            "telephone_number": "909-886-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3972 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924041700",
            "telephone_number": "909-886-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-20",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "JUSTIN",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-886-4864",
        "authorized_official_credential": "DDS INC"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Irene Wiechert
• Wilbur a. Pulido
• Tanesha NA Qua Wilcots
• Tania D Wilcox
• Courtney Ann Wild
• Tamiko Ann Wiley
• Victoria Wilging, MS, MFTI
• Josefina Wilhelm-Szasz, PH.D.
• Cynthia Wilhite, PPS
• Alyssa Christine Wilken, M.A.

• General Practice Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.