Active NPI
Scott Jereb, D.D.S., M.S.
- Dentist
- Petaluma, CA
National Provider Identifier
1730515289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62644
- Practice address
- 216 Howard St
Petaluma, CA 94952-2719 - Phone
- (707) 763-8088
- NPI assigned
- Sep 16, 2013
- Last updated
- Sep 16, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 62644 | CA | Primary |
Addresses
Primary practice location
216 Howard St
Petaluma, CA 94952-2719
Mailing address
216 Howard St
Petaluma, CA 94952-2719
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62644 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379289600000",
"number": "1730515289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 HOWARD ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 HOWARD ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522719",
"telephone_number": "707-763-8088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEREB",
"first_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-16",
"last_updated": "2013-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.