Walnut Creek-Danville Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

30346 Issued in CA

Legal business name

WALNUT CREEK-DANVILLE ORAL SURGERY

Practice address

1855 San Miguel Dr
Suite 25
Walnut Creek, CA 94596-5279

Phone

(925) 934-5565

Fax

(925) 934-6003

NPI assigned

Jan 20, 2011

Last updated

Jan 29, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Terri Matulovich

Title

Office Manager

Phone

(925) 934-5565

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

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.

• David M Rainero, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Walnut Creek, CA
  • NPI 1255430849
  NPD

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

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517184000000",
    "number": "1679878763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 SAN MIGUEL DR",
            "address_2": "SUITE 25",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965279",
            "telephone_number": "925-934-5565",
            "fax_number": "925-934-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 SAN MIGUEL DR",
            "address_2": "SUITE 25",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965279",
            "telephone_number": "925-934-5565",
            "fax_number": "925-934-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALNUT CREEK-DANVILLE ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-20",
        "last_updated": "2018-01-29",
        "status": "A",
        "authorized_official_last_name": "MATULOVICH",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "925-934-5565"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "30346",
            "primary": true
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "37490",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walnut Creek Surgery Center LLC
• Walnut Creek Surgical Assoicates, Inc
• Walnut Creek Urgent Care
• Walnut Creek Wellness Center
• Walnut Creek Willows
• Dana Rose Walsh, MFT
• John W. Walsh, MD
• Jill Gregori Walson, MS CCC-SLP
• Miriam Walter, PSYD
• Diana Walters

• Oral and Maxillofacial Surgery Clinic/Center in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Oral and Maxillofacial Surgery Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.