NPIMap

Organization Active NPI

Jerrold a Hennes DDS MSD PC

Doing business as Shadowridge and Pomerado Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Vista, CA
National Provider Identifier
1770646317
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DI34494 Issued in CA
Legal business name
JERROLD A HENNES DDS MSD PC
Doing business as
Shadowridge and Pomerado Orthodontics
Practice address
1950 Shadowridge Drive
Suite a
Vista, CA 92083
Phone
(760) 598-1707
Fax
(760) 598-2907
NPI assigned
Dec 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jerrold Alan Hennes, DDS MSDNPI 1487243051
Title
Orthodontist
Phone
(760) 598-1707

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DI34494 CA Primary

Addresses

Primary practice location

1950 Shadowridge Drive
Suite a
Vista, CA 92083

Mailing address

1950 Shadowridge Drive
Suite a
Vista, CA 92083
Phone (760) 598-1707

Other names 1

  • Shadowridge and Pomerado Orthodontics Doing business as

National Provider Directory

National Provider Directory

Locations

1950 Shadowridge Dr
#A
Vista, CA 92081
Phone (760) 598-1707

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770646317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 SHADOWRIDGE DRIVE",
            "address_2": "SUITE A",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "92083",
            "telephone_number": "760-598-1707",
            "fax_number": "760-598-2907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 SHADOWRIDGE DRIVE",
            "address_2": "SUITE A",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "92083",
            "telephone_number": "760-598-1707",
            "fax_number": "760-598-2907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERROLD A HENNES DDS MSD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENNES",
        "authorized_official_first_name": "JERROLD",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "760-598-1707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "DI34494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shadowridge and Pomerado Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.