Justin Leroy Bermudez

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS109747 Issued in CA

Practice address

630 Alhambra Blvd
Sacramento, CA 95816-3806

Phone

(916) 201-0074

NPI assigned

Apr 24, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713657600000",
    "number": "1740978246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ALHAMBRA BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958163806",
            "telephone_number": "916-201-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ALHAMBRA BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958163806",
            "telephone_number": "916-201-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMUDEZ",
        "first_name": "JUSTIN",
        "middle_name": "LEROY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-24",
        "last_updated": "2024-04-21",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS109747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriella Bermingham
• Maritza Eileen Bermudez Barron
• Dante Bermudez
• Eduardo S. Bermudez, MD
• Eva Gallego Bermudez
• Rita Brown Bermudez, MD
• Samantha S Bermudez
• Tatiana Darinca Bernabe
• Alison Bernal Granados
• Tesia Sinai Bernal Mancilla

• General Practice Dentistry in Sacramento, CA
• Providers in Sacramento, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2024; 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.

Verify at the official NPI Registry.