NPIMap

Organization Active NPI

Greenhaven Family Dental LLC

  • Dental Clinic/Center
  • Sacramento, CA
National Provider Identifier
1730771353
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
GREENHAVEN FAMILY DENTAL LLC
Doing business as
GreenHaven Family Dental LLC
Practice address
925 Secret River Dr Ste a
Sacramento, CA 95831-3465
Phone
(916) 421-3815
NPI assigned
Feb 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Authorized official

Name
Dr. Jerome PielagoNPI 1770786907
Title
Managing Dentist/Owner
Phone
(916) 412-5034

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

925 Secret River Dr Ste a
Sacramento, CA 95831-3465

Mailing address

925 Secret River Dr Ste a
Sacramento, CA 95831-3465
Phone (916) 421-3815

Other names 1

  • GreenHaven Family Dental LLC Doing business as

National Provider Directory

National Provider Directory

Locations

925 Secret River Dr
Ste A
Sacramento, CA 95831
Phone (916) 391-2888

Practitioners & affiliated clinicians

Practitioners 2

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": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1730771353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 SECRET RIVER DR STE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958313465",
            "telephone_number": "916-421-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 SECRET RIVER DR STE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958313465",
            "telephone_number": "916-421-3815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENHAVEN FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "PIELAGO",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "MANAGING DENTIST/OWNER",
        "authorized_official_telephone_number": "916-412-5034",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GreenHaven Family Dental LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.