Individual provider Active NPI

Vera Kenderian, DDS

  • Dentist
  • Rochester, MN
National Provider Identifier
1689054983
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
64488 Issued in CA
Practice address
2743 Superior Dr NW
Rochester, MN 55901-1773
Phone
(507) 288-8060
NPI assigned
Jun 2, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 64488 CA Primary

Addresses

Primary practice location

2743 Superior Dr NW
Rochester, MN 55901-1773

Mailing address

16701 Valley Blvd Ste D
Fontana, CA 92335-6696
Phone (909) 356-4490

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

LicenseStateTypeSpecialty
64488CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dentistry for Children and Adolescents, LTD. PastSince Oct 11, 2020 Accepting new patients
Paramed Services, Inc. PastSince Oct 11, 2020 Accepting new patients
Clinica Dental Familiar Guadalupana Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1689054983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16701 VALLEY BLVD STE D",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356696",
            "telephone_number": "909-356-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2743 SUPERIOR DR NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559011773",
            "telephone_number": "507-288-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDERIAN",
        "first_name": "VERA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-02",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "64488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.