Active NPI
Jessica V Fuentes-Colasse, D.D.S
- Dentist
- Santa Rosa, CA
National Provider Identifier
1992072060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61011
- Practice address
- 1144 Sonoma Ave Ste 108
Santa Rosa, CA 95405-4812 - Phone
- (707) 523-2399
- NPI assigned
- Nov 17, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61011 | CA | Primary |
Addresses
Primary practice location
1144 Sonoma Ave Ste 108
Santa Rosa, CA 95405-4812
Mailing address
716 Yacht Harbor Dr Unit 204
Las Vegas, NV 89145-2904
Phone (702) 716-5938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61011 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherag Dinshaw Sarkari DDS a Dental Corporation | Past | Accepting new patients | |
| Western Dental Services, Inc. | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Santa Rosa, CA
- NPI 1912061656
-
- Dentist
- Santa Rosa, CA
- NPI 1023582657
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321488000000",
"number": "1992072060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "716 YACHT HARBOR DR UNIT 204",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891452904",
"telephone_number": "702-716-5938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1144 SONOMA AVE STE 108",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954054812",
"telephone_number": "707-523-2399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES-COLASSE",
"first_name": "JESSICA",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-17",
"last_updated": "2011-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "61011",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.