NPIMap

Organization Active NPI

Convalescent Dental Care

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1982759148
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20552 Issued in CA
Legal business name
CONVALESCENT DENTAL CARE
Practice address
6226 Half W Manchester Ave
Los Angeles, CA 90045
Phone
(310) 215-9156
NPI assigned
Jan 25, 2007
Last updated
Apr 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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

Authorized official

Name
Algis V. LasasNPI 1669527826
Title
Sole Proprietor
Phone
(310) 215-9156

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)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 20552 CA Primary

Addresses

Primary practice location

6226 Half W Manchester Ave
Los Angeles, CA 90045

Mailing address

6226 1 Half W. Manchester Ave.
Los Angeles, CA 90045
Phone (310) 215-9156

Other identifiers 2

IdentifierTypeStateIssuer
B20552MedicaidCA
B20552-01MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334188800000",
    "number": "1982759148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6226 1 HALF W. MANCHESTER AVE.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90045",
            "telephone_number": "310-215-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6226 HALF W MANCHESTER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90045",
            "telephone_number": "310-215-9156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVALESCENT DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2012-04-12",
        "status": "A",
        "authorized_official_last_name": "LASAS",
        "authorized_official_first_name": "ALGIS",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "310-215-9156"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "20552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B20552",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B20552-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; 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.