Casey Vidovich

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

63592 Issued in CA

Practice address

30575 Trabuco Canyon Rd
Suite 106
Trabuco Canyon, CA 92679-3034

Phone

(949) 858-5147

NPI assigned

Jul 22, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

State licenses

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

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405987200000",
    "number": "1871901827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30575 TRABUCO CANYON RD",
            "address_2": "SUITE 106",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926793034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30575 TRABUCO CANYON RD",
            "address_2": "SUITE 106",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926793034",
            "telephone_number": "949-858-5147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDOVICH",
        "first_name": "CASEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-22",
        "last_updated": "2014-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jose Arturo Valdez
• Candace Monique Vallarta
• Reianne Vallejo
• Haley Morgan Veltz, RADT
• Samantha Joann Venable, N.P.
• Gabriela Villafuerte, FNP-BC, PMHNP-BC
• Village Behavioral Services LLC
• Ashley Vu
• Jennifer Lynne Walker, RADT
• Jacob Walsh, M.ED., BCBA

• General Practice Dentistry in Trabuco Canyon, CA
• Providers in Trabuco Canyon, 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 22, 2014; 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.