Individual provider Active NPI

John Paul Drennan III, DDS

  • General Practice Dentistry
  • Long Beach, CA
National Provider Identifier
1689694416
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
24286 Issued in CA
Practice address
1777 N Bellflower Blvd
#204
Long Beach, CA 90815-4013
Phone
(562) 597-8104
Fax
(562) 597-6424
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 24286 CA Primary

Addresses

Primary practice location

1777 N Bellflower Blvd
#204
Long Beach, CA 90815-4013

Mailing address

1777 N Bellflower Blvd
#204
Long Beach, CA 90815-4013
Phone (562) 597-8104

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
24286CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689694416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 N BELLFLOWER BLVD",
            "address_2": "#204",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908154013",
            "telephone_number": "562-597-8104",
            "fax_number": "562-597-6424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 N BELLFLOWER BLVD",
            "address_2": "#204",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908154013",
            "telephone_number": "562-597-8104",
            "fax_number": "562-597-6424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRENNAN",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "24286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.