Samantha Bordener, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

107447 Issued in CA

Practice address

1559 Pacific Coast Hwy Ste 101
Hermosa Beach, CA 90254-3214

Phone

(310) 372-7686

NPI assigned

May 4, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oates and Jefferson Dental Corporation

  dba Hermosa Smiles Dentistry

  • General Practice Dentistry
  • Hermosa Beach, CA
  • NPI 1174961536
  NPD (past)

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

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656892800000",
    "number": "1811570153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1559 PACIFIC COAST HWY STE 101",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902543214",
            "telephone_number": "310-372-7686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1559 PACIFIC COAST HWY STE 101",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902543214",
            "telephone_number": "310-372-7686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDENER",
        "first_name": "SAMANTHA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-04",
        "last_updated": "2022-07-04",
        "certification_date": "2022-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "107447",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Sarah Bogner, LCSW
• Sarah Ashley Bolla, BCBA
• Eloisa Bonilla, LMFT
• Linda Elizabeth Bonilla
• Whitney Boole Williams, LMFT
• Cassandra L Bowles, PSYD
• Ashley Lauren Boyer, SLP
• BR Lab and Radiology
• Tristen Scott Bracken
• Kristine Taylor Brady, M.ED., BCBA

• General Practice Dentistry in Hermosa Beach, CA
• Providers in Hermosa Beach, 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 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.