NPIMap

Organization Active NPI

West Coast Dental

  • Dental Assistant
  • Clovis, CA
National Provider Identifier
1801186556
Registry record updated Apr 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AssistantTaxonomy code 126800000X
License
75261 Issued in CA
Legal business name
WEST COAST DENTAL
Practice address
1330 Shaw Ave Ste 103
Clovis, CA 93612-3985
Phone
(559) 325-6161
NPI assigned
Apr 14, 2011
Last updated
Apr 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2011

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

Authorized official

Name
Michael Shaun Credille, RDA
Title
Registered Dental Assistant
Phone
(559) 325-6161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Assistant 126800000X 75261 CA Primary

Addresses

Primary practice location

1330 Shaw Ave Ste 103
Clovis, CA 93612-3985

Mailing address

1330 Shaw Ave Ste 103
Clovis, CA 93612-3985
Phone (559) 325-6161

National Provider Directory

National Provider Directory
Tax ID family
Dental Group of Clovis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1330 Shaw Ave
Ste 103
Clovis, CA 93612
Phone (559) 325-6161

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1302739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302739200000",
    "number": "1801186556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 SHAW AVE STE 103",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936123985",
            "telephone_number": "559-325-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 SHAW AVE STE 103",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936123985",
            "telephone_number": "559-325-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COAST DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-14",
        "last_updated": "2011-04-14",
        "status": "A",
        "authorized_official_last_name": "CREDILLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SHAUN",
        "authorized_official_title_or_position": "REGISTERED DENTAL ASSISTANT",
        "authorized_official_telephone_number": "559-325-6161",
        "authorized_official_credential": "RDA"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "75261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; 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.