NPIMap

Organization Active NPI

Loma Linda Children'S Dental Group

  • Pediatric Dentistry
  • Loma Linda, CA
National Provider Identifier
1750435368
Registry record updated Apr 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
43267 Issued in CA
Legal business name
LOMA LINDA CHILDREN'S DENTAL GROUP
Practice address
25455 Barton Rd
Suite 205B
Loma Linda, CA 92354-3128
Phone
(909) 796-2507
Fax
(909) 796-3247
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2013

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

Authorized official

Name
Dr. Christopher E Wacker, DDSNPI 1609894864
Title
Owner
Phone
(909) 796-2507

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 43267 CA Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 43508 CA
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 36101 CA

Addresses

Primary practice location

25455 Barton Rd
Suite 205B
Loma Linda, CA 92354-3128

Mailing address

25455 Barton Rd
Suite 205B
Loma Linda, CA 92354-3128
Phone (909) 796-2507

Other names 1

  • Chris Wacker, LLCDG Inc. Doing business as

National Provider Directory

National Provider Directory

Locations

25455 Barton Rd
Ste 205B
Loma Linda, CA 92354
Phone (909) 796-2507

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1750435368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25455 BARTON RD",
            "address_2": "SUITE 205B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543128",
            "telephone_number": "909-796-2507",
            "fax_number": "909-796-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25455 BARTON RD",
            "address_2": "SUITE 205B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543128",
            "telephone_number": "909-796-2507",
            "fax_number": "909-796-3247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOMA LINDA CHILDREN'S DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "WACKER",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-796-2507",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "43267",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "43508",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "36101",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chris Wacker, LLCDG Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; 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.