NPIMap

Organization Active NPI

Tooth Fairy Dental Group

  • Dentist
  • Temecula, CA
National Provider Identifier
1962658690
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D44924 Issued in CA
Legal business name
TOOTH FAIRY DENTAL GROUP
Practice address
28350 Via Santa Rosa
Temecula, CA 92590-5335
Phone
(619) 259-4001
NPI assigned
Aug 13, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Nathaniel S Liu, DDSNPI 1609930007
Title
President
Phone
(619) 259-4001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D44924 CA Primary

Addresses

Primary practice location

28350 Via Santa Rosa
Temecula, CA 92590-5335

Mailing address

1040 Tierra del Rey Ste 103
Chula Vista, CA 91910-7865
Phone (619) 482-1210

Other practice location 1

1040 Tierra Del Rey Ste 103
Chula Vista, CA 91910-7865
Phone (619) 482-1210

National Provider Directory

National Provider Directory
Tax ID family
Dr Nathaniel S Liu DDS a Professional Corporation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1962658690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 TIERRA DEL REY STE 103",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919107865",
            "telephone_number": "619-482-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28350 VIA SANTA ROSA",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925905335",
            "telephone_number": "619-259-4001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1040 Tierra Del Rey Ste 103",
            "address_purpose": "LOCATION",
            "city": "Chula Vista",
            "state": "CA",
            "postal_code": "919107865",
            "country_code": "US",
            "telephone_number": "619-482-1210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TOOTH FAIRY DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "NATHANIEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-259-4001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "D44924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.