NPIMap

Organization Active NPI

Manavi Dental Corporation

Doing business as Magicland Children's Dentistry & Orthodontics Dental Group

  • General Practice Dentistry
  • Jurupa Valley, CA
National Provider Identifier
1861179202
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MANAVI DENTAL CORPORATION
Doing business as
Magicland Children's Dentistry & Orthodontics Dental Group
Practice address
4176 Pyrite Street
Suite 101
Jurupa Valley, CA 92509
Phone
(310) 820-9933
Fax
(310) 820-0408
NPI assigned
Jun 28, 2023
Last updated
Feb 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Authorized official

Name
Miguel Reyes
Title
Q/a Contract & Compliance Manager
Phone
(310) 409-4225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

4176 Pyrite Street
Suite 101
Jurupa Valley, CA 92509

Mailing address

12121 Wilshire Blvd Ste 1111
Los Angeles, CA 90025-1188
Phone (310) 820-9933

Other names 1

  • MAGICLAND CHILDREN'S DENTISTRY & ORTHODONTICS DENTAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Manavi Dental Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

4176 Pyrite St
Bldg 10
Jurupa Valley, CA 92509

4176 Pyrite St
Ste 101
Jurupa Valley, CA 92509

NPI Registry JSON

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

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738886400000",
    "number": "1861179202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12121 WILSHIRE BLVD STE 1111",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251188",
            "telephone_number": "310-820-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4176 PYRITE STREET",
            "address_2": "SUITE 101",
            "city": "JURUPA VALLEY",
            "state": "CA",
            "postal_code": "92509",
            "telephone_number": "310-820-9933",
            "fax_number": "310-820-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANAVI DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-28",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_title_or_position": "Q/A CONTRACT & COMPLIANCE MANAGER",
        "authorized_official_telephone_number": "310-409-4225"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAGICLAND CHILDREN'S DENTISTRY & ORTHODONTICS DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jurupa Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; 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.