Bolsa Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44934 Issued in CA

Legal business name

BOLSA DENTAL CENTER

Practice address

11695 Slate Ave Ste 200
Riverside, CA 92505-5197

Phone

(951) 353-0050

Fax

(951) 353-0060

NPI assigned

Sep 27, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Truc Trung Mai, D.D.S.

Title

Dentist

Phone

(951) 353-0050

Specialties & licenses 2

Addresses

Other names 1

• Riverwalk Dental Spa Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hieu Trung Mai, D.M.D.

  • Dentist
  • Riverside, CA
  • NPI 1972952448
  NPD (past)

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1972052322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11695 SLATE AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925055197",
            "telephone_number": "951-353-0050",
            "fax_number": "951-353-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11695 SLATE AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925055197",
            "telephone_number": "951-353-0050",
            "fax_number": "951-353-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLSA DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-27",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "MAI",
        "authorized_official_first_name": "TRUC",
        "authorized_official_middle_name": "TRUNG",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "951-353-0050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44934",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44933",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverwalk Dental Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joshua Bolen
• Sylvia Bolin, RPH
• Bolivar Family Medical Clinic a Medical Corporation
• Gabriela Bolivar Villalobos, PH.D.
• Luis Fernando Bolivar, LIC. MFT
• Richard Bolter
• Rishi Bommannan, MD
• Montana Bonaiuto
• Bond Dental
• Ian Bond

• General Practice Dentistry in Riverside, CA
• Providers in Riverside, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.