Active NPI
Austin Gustavo Nunez, DDS, MPH
- Pediatric Dentistry
- Petaluma, CA
National Provider Identifier
1922319169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 100277
- Practice address
- 301 Washington St Ste B
Petaluma, CA 94952-2914 - Phone
- (707) 658-2320
- NPI assigned
- Jun 22, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 25568 | TX | |
| Pediatric Dentistry | 1223P0221X | 100277 | CA | Primary |
Addresses
Primary practice location
301 Washington St Ste B
Petaluma, CA 94952-2914
Mailing address
301 Washington St Ste B
Petaluma, CA 94952-2914
Phone (707) 658-2320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100277 | CA | MD | Clinical Social Worker |
| 25568 | TX | MD | Dentist |
Interoperability endpoints
- anunez338202@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649289600000",
"number": "1922319169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 WASHINGTON ST STE B",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522914",
"telephone_number": "707-658-2320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 WASHINGTON ST STE B",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522914",
"telephone_number": "707-658-2320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUNEZ",
"first_name": "AUSTIN",
"middle_name": "GUSTAVO",
"name_prefix": "Dr.",
"credential": "DDS, MPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-22",
"last_updated": "2022-04-07",
"certification_date": "2021-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "25568",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "100277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.