NPIMap

Organization Active NPI

Reymond Bautista Dental Corporation

Doing business as Land Park Modern Dentistry Dental Group

  • General Practice Dentistry
  • Sacramento, CA
National Provider Identifier
1679039960
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
REYMOND BAUTISTA DENTAL CORPORATION
Doing business as
Land Park Modern Dentistry Dental Group
Practice address
3640 Crocker Ave Ste 130
Sacramento, CA 95818-3970
Phone
(916) 550-9429
Fax
(916) 246-1517
NPI assigned
Feb 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

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

Authorized official

Name
Dr. Reymond C. Bautista, DDS
Title
Owner
Phone
(916) 550-9429

Specialties & licenses 1

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

Addresses

Primary practice location

3640 Crocker Ave Ste 130
Sacramento, CA 95818-3970

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8500

Other names 1

  • Land Park Modern Dentistry Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

3640 Crocker Dr
Ste 130
Sacramento, CA 95818
Phone (916) 550-9429

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659657600000",
    "number": "1679039960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8500",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 CROCKER AVE STE 130",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958183970",
            "telephone_number": "916-550-9429",
            "fax_number": "916-246-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REYMOND BAUTISTA DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-12",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "REYMOND",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-550-9429",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Land Park Modern Dentistry Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Land Park Modern Dentistry Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; 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.