NPIMap

Organization Active NPI

Santa Cruz Dental Group

  • Dentist
  • Santa Cruz, CA
National Provider Identifier
1962952762
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
32389 Issued in CA
Legal business name
SANTA CRUZ DENTAL GROUP
Practice address
1017 Mission St
Santa Cruz, CA 95060-3524
Phone
(831) 426-3535
Fax
(831) 454-0330
NPI assigned
Oct 5, 2016
Last updated
Oct 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Dr. Max WilsonNPI 1639272248
Title
Partner
Phone
(831) 426-3535

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 50398 CA
Dentist 122300000X 50395 CA
Dentist 122300000X 32389 CA Primary

Addresses

Primary practice location

1017 Mission St
Santa Cruz, CA 95060-3524

Mailing address

1017 Mission St
Santa Cruz, CA 95060-3524
Phone (831) 426-3535

Other identifiers 3

IdentifierTypeStateIssuer
1639272248OtherCADOCTOR'S NPI NUMBERS
13261317131OtherCADOCTOR'S NPI NUMBERS
1063505477OtherCADOCTOR'S NPI NUMBERS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1962952762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 MISSION ST",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950603524",
            "telephone_number": "831-426-3535",
            "fax_number": "831-454-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 MISSION ST",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950603524",
            "telephone_number": "831-426-3535",
            "fax_number": "831-454-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CRUZ DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "831-426-3535",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "50398",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "50395",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "32389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOCTOR'S NPI NUMBERS",
            "identifier": "1639272248",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOCTOR'S NPI NUMBERS",
            "identifier": "13261317131",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOCTOR'S NPI NUMBERS",
            "identifier": "1063505477",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.