Maxima Ernacio , DMD, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44167 Issued in CA

Legal business name

MAXIMA ERNACIO , DMD, INC.

Practice address

2105 Beverly Blvd
Los Angeles, CA 90057-2216

Phone

(213) 483-8756

NPI assigned

Oct 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Maxima J Ernacio, DMDNPI 1740290543

Title

President

Phone

(213) 483-8756

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maxima J Ernacio, DMD

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1740290543
  NPD (past) Authorized official

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216080000000",
    "number": "1801075676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD.",
            "address_2": "SUITE 123",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572259",
            "telephone_number": "213-483-8756",
            "fax_number": "213-483-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572216",
            "telephone_number": "213-483-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIMA ERNACIO , DMD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2008-07-15",
        "status": "A",
        "authorized_official_last_name": "ERNACIO",
        "authorized_official_first_name": "MAXIMA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-483-8756",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B44167-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, 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 Jul 15, 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.