NPIMap

Organization Active NPI

Procare Dental - Victorville

  • Dentist
  • Victorville, CA
National Provider Identifier
1790939262
Registry record updated Nov 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
50993 Issued in CA
Legal business name
PROCARE DENTAL - VICTORVILLE
Practice address
12602 Amargosa Rd
Suite D
Victorville, CA 92392-7640
Phone
(760) 951-9997
Fax
(760) 962-9424
NPI assigned
Nov 11, 2008
Organization subpart
Yes
Parent organization
PROCARE DENTAL - BARSTOWAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 11, 2008

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

Authorized official

Name
Dr. Joey Soriano Tirador, DDS
Title
President and Ceo
Phone
(760) 951-9997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 50993 CA Primary

Addresses

Primary practice location

12602 Amargosa Rd
Suite D
Victorville, CA 92392-7640

Mailing address

12602 Amargosa Rd
Suite D
Victorville, CA 92392-7640
Phone (760) 951-9997

National Provider Directory

National Provider Directory
Tax ID family
Procare Dental5 organizations share this tax ID, including this one
Part of
Procare Dental

Other organizations with this tax ID 4

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

Locations

12602 Amargosa Rd
Ste D
Victorville, CA 92392
Phone (760) 243-7701

NPI Registry JSON

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226361600000",
    "number": "1790939262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12602 AMARGOSA RD",
            "address_2": "SUITE D",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923927640",
            "telephone_number": "760-951-9997",
            "fax_number": "760-962-9424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12602 AMARGOSA RD",
            "address_2": "SUITE D",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923927640",
            "telephone_number": "760-951-9997",
            "fax_number": "760-962-9424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE DENTAL - VICTORVILLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROCARE DENTAL - BARSTOW",
        "enumeration_date": "2008-11-11",
        "last_updated": "2008-11-11",
        "status": "A",
        "authorized_official_last_name": "TIRADOR",
        "authorized_official_first_name": "JOEY",
        "authorized_official_middle_name": "SORIANO",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "760-951-9997",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "50993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; 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.