Duane Nowack a Professional Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15103 Issued in CA

Legal business name

DUANE NOWACK A PROFESSIONAL DENTAL CORPORATION

Practice address

1721 Main St Ste 108
Ramona, CA 92065-2240

Phone

(760) 789-7002

NPI assigned

Jan 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Duane C Nowack, D.D.S.

Title

Owner

Phone

(760) 789-7002

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780738203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 MAIN ST STE 108",
            "city": "RAMONA",
            "state": "CA",
            "postal_code": "920652240",
            "telephone_number": "760-789-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 MAIN ST STE 108",
            "city": "RAMONA",
            "state": "CA",
            "postal_code": "920652240",
            "telephone_number": "760-789-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUANE NOWACK A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NOWACK",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-789-7002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "15103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROV. # UNITED CONCORDIA",
            "identifier": "541022",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI- CAL",
            "identifier": "B-15103-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marki Lyn Desiena
• Desirgend Companies LLC
• Krystal Cherise Devermann, LCSW
• Huy Truong Diep, PHARMD
• Chinh N Doan, NP
• Sally E Dunn, LMFT
• Sage D Eckenroth
• Reva Gayle Edwards, BSW
• Hannah Marie Emami, MSW, PPSC
• Christine L Falkosky, D.M.D.

• General Practice Dentistry in Ramona, CA
• Providers in Ramona, CA by specialty
• General Practice Dentistry in California

• 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.