Individual provider Active NPI

Craig G Main, D.D.S.

  • General Practice Dentistry
  • San Luis Obispo, CA
National Provider Identifier
1669512778
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
50641 Issued in CA
Practice address
878 Walnut St
San Luis Obispo, CA 93401-2725
Phone
(805) 541-0550
Fax
(805) 269-1009
NPI assigned
Feb 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 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 50641 CA Primary

Addresses

Primary practice location

878 Walnut St
San Luis Obispo, CA 93401-2725

Mailing address

878 Walnut St
San Luis Obispo, CA 93401-2725
Phone (805) 541-0550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
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
I20150721002252 HI Order and Referring Only - DentistPractitioner - Dentist 1658684535

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50641CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Leopold & Murphy PC General Practice Past Accepting new patients

Organizations & group practices 1

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": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669512778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "878 WALNUT ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012725",
            "telephone_number": "805-541-0550",
            "fax_number": "805-269-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "878 WALNUT ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012725",
            "telephone_number": "805-541-0550",
            "fax_number": "805-269-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIN",
        "first_name": "CRAIG",
        "middle_name": "G",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.