Active NPI
Demetrio Sta Ana Jr DDS Inc
Doing business as Shaw Family Dental
- Dentist
- Fresno, CA
National Provider Identifier
1952581282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 43250
- Legal business name
- DEMETRIO STA ANA JR DDS INC
- Doing business as
- Shaw Family Dental
- Practice address
- 3616 W Shaw Ave
Fresno, CA 93711-3231 - Phone
- (559) 277-0111
- NPI assigned
- Nov 3, 2007
- Organization subpart
- Yes
- Parent organization
- DEMETRIO STA ANA JR DDS INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Demetrio Tagulinao Sta. Ana Jr., DDS
- Title
- President
- Phone
- (559) 277-0111
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 43250 | CA | Primary |
Addresses
Primary practice location
3616 W Shaw Ave
Fresno, CA 93711-3231
Mailing address
3616 W. Shaw Avenue
Fresno, CA 93711
Phone (559) 277-0111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43250 | Other | CA | DENTAL LICENSE |
Other names 1
- Shaw Family Dental
National Provider Directory
National Provider Directory- Part of
- Demetrio Sta Ana Jr DDS Inc
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Fresno, CA
- NPI 1487843710
-
- General Practice Dentistry
- Fresno, CA
- NPI 1679662910
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194048000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1952581282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3616 W. SHAW AVENUE",
"city": "FRESNO",
"state": "CA",
"postal_code": "93711",
"telephone_number": "559-277-0111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3616 W SHAW AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113231",
"telephone_number": "559-277-0111"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DEMETRIO STA ANA JR DDS INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DEMETRIO STA ANA JR DDS INC",
"enumeration_date": "2007-11-03",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "STA. ANA",
"authorized_official_first_name": "DEMETRIO",
"authorized_official_middle_name": "TAGULINAO",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "559-277-0111",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "CA",
"license": "43250",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "43250",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Shaw Family Dental",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.