Mark J Redd, D.D.S

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

44438 Issued in CA

Practice address

25261 Paseo de Valencia
Laguna Hills, CA 92637-4966

Phone

(949) 581-6641

Fax

(949) 581-2831

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962591644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25261 PASEO DE VALENCIA",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926374966",
            "telephone_number": "949-581-6641",
            "fax_number": "949-581-2831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25261 PASEO DE VALENCIA",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926374966",
            "telephone_number": "949-581-6641",
            "fax_number": "949-581-2831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDD",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "44438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Real
• Darryl Anthony Reames, DC
• Jeffrey Carrol Reaves, PTA
• Rebecca O'Connell, LMFT
• Recovery Services Management LLC
• Danielle Marie Reddel, LMFT
• Katherine Christine Redden, PA
• David Norman Reed, PH.D., MFT, CEAP
• Wendi Jazmin Regalado Rayo
• Carissa Lee Regan, D.P.T.

• Periodontics in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.