McCormack Dental Imaging

Primary specialty

Dental LaboratoryTaxonomy code 292200000X

License

RHP00053519 Issued in CA

Legal business name

MCCORMACK DENTAL IMAGING

Practice address

1550 Hotel Cir N
Ste. 340
San Diego, CA 92108-2901

Phone

(619) 296-6132

NPI assigned

Oct 15, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Jerome N. Peck, DLXT

Title

Ceo

Phone

(415) 421-1389

Specialties & licenses 1

Addresses

Tax ID family

McCormack Dental Imaging2 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.

• McCormack Dental Imaging

  • Dental Laboratory
  • La Mesa, CA
  • NPI 1598137184
  NPD tax ID

Locations

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

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444867200000",
    "number": "1689045718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 SUTTER ST",
            "address_2": "SUITE 1542",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941084206",
            "telephone_number": "415-421-1389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 HOTEL CIR N",
            "address_2": "STE. 340",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082901",
            "telephone_number": "619-296-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCORMACK DENTAL IMAGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-15",
        "last_updated": "2015-10-15",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-421-1389",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DLXT"
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "CA",
            "license": "RHP00053519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Commerina Theodora McConnin, NNP
• Meghan C McCool, RN, CCRN. MBA
• Karen Joyce McCord-Sullivan, PT
• Gregory Bradford McCord, MA, MDIV.
• Monica J. McCorkle, MS, RD, CDE
• Teresa Ann McCormack, RN, IBCLC
• Alice Chrysanthemum McCormick
• George McCormick
• Jamey McCormick
• Sarah Kathleen McCormick, BSN, RN

• Dental Laboratory in San Diego, CA
• Providers in San Diego, CA by specialty
• Dental Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; 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.