NPIMap

Organization Active NPI

Untalan Dental Corporation

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1881711281
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
49693 Issued in CA
Legal business name
UNTALAN DENTAL CORPORATION
Practice address
730 S Western Ave
Suite 202
Los Angeles, CA 90005-3193
Phone
(213) 385-3828
Fax
(213) 385-2144
NPI assigned
Mar 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Charise R UntalanNPI 1255496782
Title
VP
Phone
(213) 385-3828

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 49693 CA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 49984 CA

Addresses

Primary practice location

730 S Western Ave
Suite 202
Los Angeles, CA 90005-3193

Mailing address

730 S Western Ave
Suite 202
Los Angeles, CA 90005-3193
Phone (213) 385-3828

Other identifiers 2

IdentifierTypeStateIssuer
B49693-01OtherCADELTA DENTAL HEALTHY FAMI
G9241201OtherCADENTICAL PROV NUM

National Provider Directory

National Provider Directory
Tax ID family
Untalan Dental Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

730 S Western Ave
Ste 202
Los Angeles, CA 90005
Phone (213) 385-3828

Practitioners & affiliated clinicians

Practitioners 2

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": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881711281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 S WESTERN AVE",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900053193",
            "telephone_number": "213-385-3828",
            "fax_number": "213-385-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 S WESTERN AVE",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900053193",
            "telephone_number": "213-385-3828",
            "fax_number": "213-385-2144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNTALAN DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "UNTALAN",
        "authorized_official_first_name": "CHARISE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "213-385-3828",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49693",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49984",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL HEALTHY FAMI",
            "identifier": "B49693-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL PROV NUM",
            "identifier": "G9241201",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.