NPIMap

Organization Active NPI

Guy W Mendivil, D.D.S. Professional Dental Corporation

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Oceanside, CA
National Provider Identifier
1902073307
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
GUY W MENDIVIL, D.D.S. PROFESSIONAL DENTAL CORPORATION
Practice address
3998 Vista Way Suite B
Oceanside, CA 92056
Phone
(760) 945-1420
Fax
(760) 945-4692
NPI assigned
May 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Authorized official

Name
Mr. Guy W Mendivil, DDS
Title
Owner
Phone
(760) 945-4692

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X D29737 CA
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X CA Primary

Addresses

Primary practice location

3998 Vista Way Suite B
Oceanside, CA 92056

Mailing address

3998 Vista Way Suite B
Oceanside, CA 92056
Phone (760) 945-1420

Other identifiers 2

IdentifierTypeStateIssuer
G93914-02OtherCAMEDI-CAL/DENTI-CAL
G9391402OtherCADENTI-CAL PROVIDER

Other names 1

  • Tri-City Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bakersfield Orthodontic Dental Group2 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.

NPI Registry JSON

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1902073307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3998 VISTA WAY SUITE B",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92056",
            "telephone_number": "760-945-1420",
            "fax_number": "760-945-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 VISTA WAY SUITE B",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92056",
            "telephone_number": "760-945-1420",
            "fax_number": "760-945-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUY W MENDIVIL, D.D.S. PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "MENDIVIL",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-945-4692",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "D29737",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL/DENTI-CAL",
            "identifier": "G93914-02",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL PROVIDER",
            "identifier": "G9391402",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-City Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oceanside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; 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.