Active NPI
Indulal M. Nagrecha, D.D.S.
- Pediatric Dentistry
- Santa Monica, CA
National Provider Identifier
1760409692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 28962
- Practice address
- 2509 Pico Blvd
Venice Family Clinic
Santa Monica, CA 90405-1828 - Phone
- (310) 664-7885
- Fax
- (310) 664-7590
- NPI assigned
- Jul 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 28962 | CA | Primary |
Addresses
Primary practice location
2509 Pico Blvd
Venice Family Clinic
Santa Monica, CA 90405-1828
Mailing address
2509 Pico Blvd
Venice Family Clinic
Santa Monica, CA 90405-1828
Phone (310) 664-7885
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B28962-01 | Other | CA | DENTI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28962 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338422400000",
"number": "1760409692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2509 PICO BLVD",
"address_2": "VENICE FAMILY CLINIC",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904051828",
"telephone_number": "310-664-7885",
"fax_number": "310-664-7590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2509 PICO BLVD",
"address_2": "VENICE FAMILY CLINIC",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904051828",
"telephone_number": "310-664-7885",
"fax_number": "310-664-7590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAGRECHA",
"first_name": "INDULAL",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-16",
"last_updated": "2012-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "28962",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTI-CAL",
"identifier": "B28962-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.