NPIMap

Organization Active NPI

Etemadi Dental Corporation

  • Dentist
  • Rancho Cucamonga, CA
National Provider Identifier
1699842492
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ETEMADI DENTAL CORPORATION
Practice address
12729 Foothill Blvd
Suite # a
Rancho Cucamonga, CA 91739-9334
Phone
(909) 899-8757
Fax
(909) 899-8760
NPI assigned
Nov 29, 2006
Last updated
Oct 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Authorized official

Name
Dr. Khashayar Etemadi, DDS
Title
President
Phone
(909) 899-8757

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU

Addresses

Primary practice location

12729 Foothill Blvd
Suite # a
Rancho Cucamonga, CA 91739-9334

Mailing address

12729 Foothill Blvd
Suite # a
Rancho Cucamonga, CA 91739-9334
Phone (909) 899-8757

Other identifiers 2

IdentifierTypeStateIssuer
868675OtherCAUNITED CONCORDIA
G9124301OtherCAMEDICAL

National Provider Directory

National Provider Directory

Locations

12729 Foothill Blvd
Ste A
Rancho Cucamonga, CA 91739
Phone (909) 899-8757

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1699842492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12729 FOOTHILL BLVD",
            "address_2": "SUITE # A",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917399334",
            "telephone_number": "909-899-8757",
            "fax_number": "909-899-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12729 FOOTHILL BLVD",
            "address_2": "SUITE # A",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917399334",
            "telephone_number": "909-899-8757",
            "fax_number": "909-899-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETEMADI DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "ETEMADI",
        "authorized_official_first_name": "KHASHAYAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-899-8757",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "868675",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "G9124301",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; 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.