Irene M Justin Wildwood Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

51084 Issued in CA

Legal business name

IRENE M JUSTIN WILDWOOD DENTAL GROUP

Practice address

3972 N Waterman Ave Ste 110
San Bernardino, CA 92404-1767

Phone

(909) 947-9700

NPI assigned

Oct 23, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Irene Justin, DDS

Title

President

Phone

(951) 536-8419

Specialties & licenses 1

Addresses

Tax ID family

Irene M Justin Wildwood Dental Group2 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.

• Wildwood Dental Group

  • General Practice Dentistry
  • San Bernardino, CA
  • NPI 1659798262
  NPD tax ID

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256256000000",
    "number": "1689900870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2413 S GROVE AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917616225",
            "telephone_number": "909-947-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3972 N WATERMAN AVE STE 110",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924041767",
            "telephone_number": "909-947-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRENE M JUSTIN WILDWOOD DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "JUSTIN",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-536-8419",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hana Yoatsi Inzunza Ruiz
• Vanessa Lonokahekini Inzunza
• Iram Iqbal
• Cyrus Iranipour, D.C.
• Leslie Irazoque-Gomez
• Irene P Lou, OD Inc
• Irving M. Feldkamp DDS
• Isha Inc
• Anita Marie Islas, LMFT
• Ousama Ismael, MD

• General Practice Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; 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.