Marvin Eiji Ota, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28214 Issued in CA

Practice address

11834 Bryant St Ste 103
Yucaipa, CA 92399-3848

Phone

(909) 797-8090

Fax

(909) 797-8090

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Marvin E. Ota, DDS

  • General Practice Dentistry
  • Yucaipa, CA
  • NPI 1699901082
  NPD (past) Authorized official
• Ota Dental Corp

  • Health Maintenance Organization
  • Yucaipa, CA
  • NPI 1043559453
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1871675165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11834 BRYANT ST STE 103",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923993848",
            "telephone_number": "909-797-8090",
            "fax_number": "909-797-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11834 BRYANT ST STE 103",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923993848",
            "telephone_number": "909-797-8090",
            "fax_number": "909-797-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTA",
        "first_name": "MARVIN",
        "middle_name": "EIJI",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "28214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B28214-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chien Originales, PHARMD
• Emily Ortiz
• Richard Ortiz
• Alyson Ostdiek
• Ota Dental Corp
• Macdaly Owens, FNP, RN
• Sooh Park
• Amanda Elise Parker
• Dwight Andrew Parker, PT
• Jaleh M Parrish

• General Practice Dentistry in Yucaipa, CA
• Providers in Yucaipa, 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 9, 2007; 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.