NPIMap

Organization Active NPI

Copper Canyon Smiles

  • General Practice Dentistry
  • Murrieta, CA
National Provider Identifier
1669908893
Registry record updated May 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
53453 Issued in CA
Legal business name
COPPER CANYON SMILES
Practice address
23771 Washington Ave
Suite H102
Murrieta, CA 92562-2278
Phone
(951) 691-5096
Fax
(951) 691-5097
NPI assigned
May 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2017

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

Authorized official

Name
Crystal Quintero
Title
Biller
Phone
(951) 691-5096

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 53453 CA Primary

Addresses

Primary practice location

23771 Washington Ave
Suite H102
Murrieta, CA 92562-2278

Mailing address

23771 Washington Ave
Suite H102
Murrieta, CA 92562-2278
Phone (951) 691-5096

Other identifiers 1

IdentifierTypeStateIssuer
1881095115MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Copper Canyon Smiles2 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.

NPI Registry JSON

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

{
    "created_epoch": "1494288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494288000000",
    "number": "1669908893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23771 WASHINGTON AVE",
            "address_2": "SUITE H102",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925622278",
            "telephone_number": "951-691-5096",
            "fax_number": "951-691-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23771 WASHINGTON AVE",
            "address_2": "SUITE H102",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925622278",
            "telephone_number": "951-691-5096",
            "fax_number": "951-691-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER CANYON SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-09",
        "last_updated": "2017-05-09",
        "status": "A",
        "authorized_official_last_name": "QUINTERO",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "951-691-5096"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881095115",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; 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.