NPIMap

Organization Active NPI

Misner Dental Corp

  • General Practice Dentistry
  • Huntington Park, CA
National Provider Identifier
1811275670
Registry record updated Jul 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
51044 Issued in CA
Legal business name
MISNER DENTAL CORP
Practice address
2621 Zoe Ave
Suite a
Huntington Park, CA 90255-4131
Phone
(818) 335-2100
NPI assigned
Jul 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2023

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

Authorized official

Name
Shaun Urbanozo
Title
Credentialing Manager
Phone
(719) 323-2362

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 51044 CA Primary

Addresses

Primary practice location

2621 Zoe Ave
Suite a
Huntington Park, CA 90255-4131

Mailing address

2221 E Bijou St Ste 100
Colorado Springs, CO 80909-8009
Phone (818) 335-2100

Other names 3

  • Kids Dental Place Doing business as
  • Kids and Family Dental place Doing business as
  • Jack Bayramyan Dental Corp Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Jack Bayramyan Dental Corp2 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

2621 Zoe Ave
Ste A
Huntington Park, CA 90255
Phone (818) 335-2100

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688342400000",
    "number": "1811275670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "818-335-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 ZOE AVE",
            "address_2": "SUITE A",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554131",
            "telephone_number": "818-335-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISNER DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-28",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A",
        "authorized_official_last_name": "URBANOZO",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-323-2362"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Dental Place",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kids and Family Dental place",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jack Bayramyan Dental Corp",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; 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.