NPIMap

Organization Active NPI

Children'S Dental Initiative

  • Dental Clinic/Center
  • San Jose, CA
National Provider Identifier
1770708299
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
G91493-02 Issued in CA
Legal business name
CHILDREN'S DENTAL INITIATIVE
Practice address
2085 Hamilton Ave
Ste. 150
San Jose, CA 95125-6117
Phone
(408) 961-9869
NPI assigned
Apr 17, 2007
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
Mr. Ira Holtzman
Title
Chief Financial Officer
Phone
(408) 961-9869

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X G91493-02 CA Primary

Addresses

Primary practice location

2085 Hamilton Ave
Ste. 150
San Jose, CA 95125-6117

Mailing address

2085 Hamilton Ave
Ste. 150
San Jose, CA 95125-6117
Phone (408) 961-9869

Other identifiers 1

IdentifierTypeStateIssuer
G91493-02MedicaidCA

Other names 1

  • THE HEALTH TRUST Other name

National Provider Directory

National Provider Directory
Tax ID family
The Health Trust5 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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770708299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 HAMILTON AVE",
            "address_2": "STE. 150",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951256117",
            "telephone_number": "408-961-9869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 HAMILTON AVE",
            "address_2": "STE. 150",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951256117",
            "telephone_number": "408-961-9869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTAL INITIATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLTZMAN",
        "authorized_official_first_name": "IRA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "408-961-9869",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "G91493-02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G91493-02",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE HEALTH TRUST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Jose, 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.