NPIMap

Organization Active NPI

Rincon Family Dental

  • General Practice Dentistry
  • Santa Rosa, CA
National Provider Identifier
1811335755
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
56052
Legal business name
RINCON FAMILY DENTAL
Practice address
55 Elaine Dr
Santa Rosa, CA 95409-4248
Phone
(707) 523-7423
NPI assigned
Jun 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

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

Authorized official

Name
Dr. Gerret W Osendorf, DDSNPI 1639363971
Title
Owner/Dentist
Phone
(707) 523-7423

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 56052 Primary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X

Addresses

Primary practice location

55 Elaine Dr
Santa Rosa, CA 95409-4248

Mailing address

55 Elaine Dr
Santa Rosa, CA 95409-4248
Phone (707) 523-7423

National Provider Directory

National Provider Directory

Locations

55 Elaine Dr
Santa Rosa, CA 95409
Phone (707) 523-7423

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1811335755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 ELAINE DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954094248",
            "telephone_number": "707-523-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 ELAINE DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954094248",
            "telephone_number": "707-523-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RINCON FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-13",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "OSENDORF",
        "authorized_official_first_name": "GERRET",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "707-523-7423",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": "56052",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; 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.