NPIMap

Organization Active NPI

North Shore Dental LLC

  • Dentist
  • Hercules, CA
National Provider Identifier
1750519682
Registry record updated Jun 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
45843 Issued in CA
Legal business name
NORTH SHORE DENTAL LLC
Practice address
500 Alfred Nobel Dr.
Suite 240
Hercules, CA 94547
Phone
(510) 741-2140
Fax
(510) 741-2142
NPI assigned
Jun 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2009

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

Authorized official

Name
Tuong-Van B. Hyland, DDSNPI 1275654394
Title
Ceo, DDS
Phone
(510) 741-2140

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: 193200000X MULTI-SPECIALTY GROUP 122300000X 45843 CA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 35608 CA

Addresses

Primary practice location

500 Alfred Nobel Dr.
Suite 240
Hercules, CA 94547

Mailing address

500 Alfred Nobel Dr.
Suite 240
Hercules, CA 94547
Phone (510) 741-2140

Other names 1

  • Betty J. Fong Corp Former legal business name

National Provider Directory

National Provider Directory

Locations

500 Alfred Nobel Dr
Ste 240
Hercules, CA 94547
Phone (510) 741-2140

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": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246320000000",
    "number": "1750519682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ALFRED NOBEL DR.",
            "address_2": "SUITE 240",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "94547",
            "telephone_number": "510-741-2140",
            "fax_number": "510-741-2142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ALFRED NOBEL DR.",
            "address_2": "SUITE 240",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "94547",
            "telephone_number": "510-741-2140",
            "fax_number": "510-741-2142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2009-06-30",
        "status": "A",
        "authorized_official_last_name": "HYLAND",
        "authorized_official_first_name": "TUONG-VAN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CEO, DDS",
        "authorized_official_telephone_number": "510-741-2140",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "45843",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "35608",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Betty J. Fong Corp",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Hercules, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; 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.