NPIMap

Organization Active NPI

Jefferson and Chokka Dental Corporation

  • General Practice Dentistry
  • Fontana, CA
National Provider Identifier
1902003593
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
JEFFERSON AND CHOKKA DENTAL CORPORATION
Practice address
16475 Sierra Lakes Parkway
Suite 140
Fontana, CA 92336
Phone
(909) 357-0869
Fax
(909) 357-4887
NPI assigned
Jun 28, 2007
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. Walter Jefferson, DDSNPI 1134239544
Title
Owner
Phone
(909) 357-0869

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

16475 Sierra Lakes Parkway
Suite 140
Fontana, CA 92336

Mailing address

2860 Michelle
2ND Floor
Irvine, CA 92606-1009
Phone (714) 508-3600

Other names 1

  • SIERRA LAKES DENTAL GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

16475 Sierra Lakes Pkwy
Ste 140
Fontana, CA 92336
Phone (909) 357-0869

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902003593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE",
            "address_2": "2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061009",
            "telephone_number": "714-508-3600",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16475 SIERRA LAKES PARKWAY",
            "address_2": "SUITE 140",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "92336",
            "telephone_number": "909-357-0869",
            "fax_number": "909-357-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON AND CHOKKA DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-357-0869",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIERRA LAKES DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fontana, 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.