Active NPI
Philippe Marc Gendreau, D.D.S.
- General Practice Dentistry
- Irvine, CA
National Provider Identifier
1730334954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 56770
- Practice address
- 4980 Barranca Pkwy
Suite 208
Irvine, CA 92604-8645 - Phone
- (949) 551-2313
- Fax
- (949) 502-8743
- NPI assigned
- Dec 2, 2008
- Last updated
- May 28, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 56770 | CA | Primary |
Addresses
Primary practice location
4980 Barranca Pkwy
Suite 208
Irvine, CA 92604-8645
Mailing address
4980 Barranca Pkwy
Suite 208
Irvine, CA 92604-8645
Phone (949) 551-2313
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
| License | State | Type | Specialty |
|---|---|---|---|
| 56770 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harder Dental Corporation | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Irvine, CA
- NPI 1891862900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401235200000",
"number": "1730334954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4980 BARRANCA PKWY",
"address_2": "SUITE 208",
"city": "IRVINE",
"state": "CA",
"postal_code": "926048645",
"telephone_number": "949-551-2313",
"fax_number": "949-502-8743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4980 BARRANCA PKWY",
"address_2": "SUITE 208",
"city": "IRVINE",
"state": "CA",
"postal_code": "926048645",
"telephone_number": "949-551-2313",
"fax_number": "949-502-8743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENDREAU",
"first_name": "PHILIPPE",
"middle_name": "MARC",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-02",
"last_updated": "2014-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "56770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.