Active NPI
Jairo Humberto Molta, DDS
- Dentist
- Fresno, CA
National Provider Identifier
1679981898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 53629
- Practice address
- 371 E Bullard Ave
Suite 118
Fresno, CA 93710-5217 - Phone
- (559) 440-0150
- Fax
- (559) 435-4370
- NPI assigned
- Jul 31, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 53629 | CA | Primary |
Addresses
Primary practice location
371 E Bullard Ave
Suite 118
Fresno, CA 93710-5217
Mailing address
371 E Bullard Ave
Suite 118
Fresno, CA 93710-5217
Phone (559) 440-0150
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 523435 | Other | CA | DENTI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53629 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1679981898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "371 E BULLARD AVE",
"address_2": "SUITE 118",
"city": "FRESNO",
"state": "CA",
"postal_code": "937105217",
"telephone_number": "559-440-0150",
"fax_number": "559-435-4370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "371 E BULLARD AVE",
"address_2": "SUITE 118",
"city": "FRESNO",
"state": "CA",
"postal_code": "937105217",
"telephone_number": "559-440-0150",
"fax_number": "559-435-4370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLTA",
"first_name": "JAIRO",
"middle_name": "HUMBERTO",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-31",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "53629",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTI-CAL",
"identifier": "523435",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.