NPIMap

Organization Active NPI

Pacific Dental Clinic

  • Preferred Provider Organization
  • Anaheim, CA
National Provider Identifier
1750575403
Registry record updated Sep 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
47897 Issued in CA
Legal business name
PACIFIC DENTAL CLINIC
Practice address
1201 N Euclid St
Anaheim, CA 92801-1954
Phone
(714) 817-8345
Fax
(714) 224-7688
NPI assigned
Sep 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2007

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

Authorized official

Name
Jorge Luis Geronimo, DDS
Title
Dentist
Phone
(714) 817-8345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 47897 CA Primary

Addresses

Primary practice location

1201 N Euclid St
Anaheim, CA 92801-1954

Mailing address

1201 N Euclid St
Anaheim, CA 92801-1954
Phone (714) 817-8345

National Provider Directory

National Provider Directory
Tax ID family
Pacific Dental Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188950400000",
    "number": "1750575403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 N EUCLID ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011954",
            "telephone_number": "714-817-8345",
            "fax_number": "714-224-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N EUCLID ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011954",
            "telephone_number": "714-817-8345",
            "fax_number": "714-224-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2007-09-05",
        "status": "A",
        "authorized_official_last_name": "GERONIMO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "714-817-8345",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "47897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; 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.