NPIMap

Organization Active NPI

Bustamante Endodontics Adc

  • Endodontics
  • Los Angeles, CA
National Provider Identifier
1710074513
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
29218 Issued in CA
Legal business name
BUSTAMANTE ENDODONTICS ADC
Practice address
11645 Wilshire Blvd
Suite 1160
Los Angeles, CA 90025-6811
Phone
(310) 473-5559
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Manuel A. Bustamante, D.D.S.NPI 1912211426
Title
President
Phone
(310) 473-5559

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X 29218 CA Primary

Addresses

Primary practice location

11645 Wilshire Blvd
Suite 1160
Los Angeles, CA 90025-6811

Mailing address

11645 Wilshire Blvd
Suite 1160
Los Angeles, CA 90025-6811
Phone (310) 473-5559

National Provider Directory

National Provider Directory

Locations

11645 Wilshire Blvd
Ste 1160
Los Angeles, CA 90025
Phone (310) 473-5559

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710074513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD",
            "address_2": "SUITE 1160",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256811",
            "telephone_number": "310-473-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD",
            "address_2": "SUITE 1160",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256811",
            "telephone_number": "310-473-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUSTAMANTE ENDODONTICS ADC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUSTAMANTE",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-473-5559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "29218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.