MCCORMACK DENTAL IMAGING (NPI# 1689045718) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689045718 |
| Entity Type | Organization |
| Organization Name | MCCORMACK DENTAL IMAGING |
| Practice Address |
1550 Hotel Cir N Ste. 340 San Diego CA 92108-2901 |
| Mailing Address |
450 Sutter St Suite 1542 San Francisco CA 94108-4206 |
| Practice Telephone | 6192966132 |
| Mailing Telephone | 4154211389 |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2015-10-15 |
| Authorized Official Name | MR. JEROME N. PECK (CEO) |
| Authorized Official Telephone | 4154211389 |
| Authorized Official Credential | DLXT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 292200000X | Dental Laboratory | RHP00053519 | CA | Laboratories |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104286996 | Mccormack Dental Imaging | Dental Laboratory | 317 N El Camino Real, Ste. 301, Encinitas, CA 92024-2811 | 2016-03-07 |
| 1598137184 | Mccormack Dental Imaging | Dental Laboratory | 8860 Center Dr, Ste. 340, La Mesa, CA 91942-3068 | 2015-10-22 |
| Street Address |
1550 HOTEL CIR N STE. 340 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92108-2901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801843784 | Diedra Ann Duchock | Psychologist | 1550 Hotel Cir N, San Diego, CA 92108-2901 | 2006-05-27 |
| 1629504089 | Anna Karen Herrera | Behavioral Analyst | 1550 Hotel Cir N, Ste. 270, San Diego, CA 92108-2901 | 2017-05-04 |
| 1003349192 | Rosalba Roxanne Caandoy | Behavioral Analyst | 1550 Hotel Cir N, Suite 270, San Diego, CA 92108-2901 | 2017-04-06 |
| 1174056493 | Jessica Orozco-ochoa | Behavior Technician | 1550 Hotel Cir N, Suite 270, San Diego, CA 92108-2901 | 2017-04-04 |
| 1164963856 | Alexis Jovann Mendez | Behavior Technician | 1550 Hotel Cir N, 450, San Diego, CA 92108-2901 | 2017-03-14 |
| 1689113342 | Ivonne Arias | Behavioral Analyst | 1550 Hotel Cir N, Suite 270, San Diego, CA 92108-2901 | 2017-02-14 |
| 1104364066 | Immanuel Nebril Caandoy | Behavioral Analyst | 1550 Hotel Cir N, Suite 270, San Diego, CA 92108-2901 | 2017-02-10 |
| 1285176073 | Diana Lopez | Behavior Technician | 1550 Hotel Cir N, Suite 270, San Diego, CA 92108-2901 | 2016-11-09 |
| 1417499393 | Dalajia Cooks | Behavior Technician | 1550 Hotel Cir N, 450, San Diego, CA 92108-2901 | 2016-11-09 |
| 1023568607 | Eric Amparo | Behavioral Analyst | 1550 Hotel Cir N, Suite 270, San Diego, CA 92108-2901 | 2016-10-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902801 | Keri Castaneda | Behavior Technician | 025 Camino Del Rio South Suite 101, San Diego, CA 92108 | 2020-11-06 |
| 1457963738 | Diyana Giorgees | Case Manager/Care Coordinator | 5005 Texas Street, St. 203, San Diego, CA 92108 | 2020-08-19 |
| 1780211896 | Lori Mildred Jerman | Marriage & Family Therapist | Healthy Minds Counseling Services, 1455 Frazee Road, Suite 880, San Diego, CA 92108 | 2020-03-26 |
| 1285260737 | Demetrius Anderson | Counselor | Telecare Corporation Ihot, 1660 Hotel Circle North, Suite 101, San Deigo, CA 92108 | 2020-03-17 |
| 1033742465 | Dasc Medical Inc | Durable Medical Equipment & Medical Supplies | 5520 Gill Village Way, 907, San Diego, CA 92108 | 2020-02-13 |
| 1508401092 | Chanda Denee Kizer | Marriage & Family Therapist | 3517 Camino Del Rio N, Suite 407, San Diego, CA 92108 | 2019-11-08 |
| 1225695562 | Jenna Rose Shurer | Nurse Practitioner | 5030 Camino De La Siesla Ste 106, San Diego, CA 92108 | 2019-05-22 |
| 1952967812 | Martha Kebede Mekonen | Chiropractor | 2667 Camino Del Rio South, Suite #313, San Diego, CA 92108 | 2019-05-16 |
| 1053886135 | Andrea Jiselly Munoz | Behavior Technician | 3505 Camino Del Rio South, Suite 200, San Diego, CA 92108 | 2018-10-04 |
| 1386128916 | Sarah Elisabeth Smith | Counselor | 7575 Metropolitan Dr., San Diego, CA 92108 | 2018-09-19 |
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| Taxonomy Code | 292200000X |
| Grouping | Laboratories |
| Classification | Dental Laboratory |
| A commercial laboratory specializing in the construction of dental appliances that conform to a dentist’s specifications including the construction of dentures (complete or partial), orthodontic appliances, bridgework, crowns, and inlays. |
| Notes: Source: Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 1245. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528308517 | Susie C. Kwok Dds Inc | Dental Laboratory | 3315 4th Ave, San Diego, CA 92103-5703 | 2013-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972074367 | Prosomnus Sleep Technologies Inc. | Dental Laboratory | 5860 W Las Positas Blvd Ste 25, Pleasanton, CA 94588-8557 | 2018-12-10 |
| 1982192290 | Dj Dental Lab Inc | Dental Laboratory | 700 N Valley St Ste F-g, Anaheim, CA 92801-3824 | 2018-04-23 |
| 1427587724 | California Dental Arts, LLC | Dental Laboratory | 20421 Pacifica Dr, Cupertino, CA 95014-3013 | 2017-06-08 |
| 1366807950 | C-dental X-ray, Inc | Dental Laboratory | 1900 Olympic Blvd, Ste. 201, Walnut Creek, CA 94596-5037 | 2015-12-23 |
| 1932576220 | Dental Digital Design | Dental Laboratory | 17781 Sky Park Cir # D, Irvine, CA 92614-6103 | 2015-08-21 |
| 1245606847 | C-dental X-ray, Inc. | Dental Laboratory | 362 W Portal Ave, San Francisco, CA 94127-1412 | 2015-08-18 |
| 1750757696 | C-dental X-ray, Inc. | Dental Laboratory | 1475 Cedarwood Ln, Ste. D, Pleasanton, CA 94566-6153 | 2015-08-14 |
| 1639588205 | John Bilder Fund Billingsworth Lab | Dental Laboratory | 7202 Greenleaf Ave, 13303 Philadelphia St, Whittier, CA 90602-1312 | 2014-08-08 |
| 1588915615 | Usc Redmond Imaging Center | Dental Laboratory | 925 W 34th St Ste 319, Los Angeles, CA 90089-0641 | 2012-09-28 |
| 1134493943 | Mike's Dental Lab | Dental Laboratory | 1735 Professional Drive, Sacramento, CA 95825 | 2012-02-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.