Individual provider Active NPI

Peter D Hara, DMD

  • Public Health Dentistry
  • Desert Hot Springs, CA
National Provider Identifier
1811252505
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
License
DDS100-960 Issued in CA
Practice address
11750 Cholla Dr Ste B
Desert Hot Springs, CA 92240-3066
Phone
(760) 251-0044
NPI assigned
Jul 9, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X DDS100-960 CA Primary

Addresses

Primary practice location

11750 Cholla Dr Ste B
Desert Hot Springs, CA 92240-3066

Mailing address

77490 Calle Arroba
La Quinta, CA 92253-3510
Phone (937) 475-4275

Other practice location 1

3292 Elida Rd
Lima, OH 45805-1249
Phone (419) 228-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161010001600 OH Order and Referring Only - DentistPractitioner - Dentist 9537457460

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS100-960CAMDPublic Health Dentist

Interoperability endpoints

  • Direct secure messaging: phara467959@direct.llu.edu

NPI Registry JSON

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1811252505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77490 CALLE ARROBA",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922533510",
            "telephone_number": "937-475-4275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11750 CHOLLA DR STE B",
            "city": "DESERT HOT SPRINGS",
            "state": "CA",
            "postal_code": "922403066",
            "telephone_number": "760-251-0044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3292 Elida Rd",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "458051249",
            "country_code": "US",
            "telephone_number": "419-228-5000",
            "fax_number": "419-221-3578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARA",
        "first_name": "PETER",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-09",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "DDS100-960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Desert Hot Springs, CA

Sources for this page

Verify at the official NPI Registry.