PARKSIDE DENTAL CARE (NPI# 1720133796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720133796 |
| Entity Type | Organization |
| Organization Name | PARKSIDE DENTAL CARE |
| Practice Address |
1325 Travis Blvd Fairfield CA 94533-4611 |
| Practice Telephone | 7074272222 |
| Practice Fax Number | 7074270562 |
| Mailing Telephone | 7074272222 |
| Mailing Fax Number | 7074270562 |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. AVRIL MAY ALTMAN (INSURANCE COORDINATOR) |
| Authorized Official Telephone | 7074272222 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 1223E0200X |
Dentist Specialization: Endodontics |
48710 | CA | Dental Providers |
| X | 1223G0001X |
Dentist Specialization: General Practice |
28479 | CA | Dental Providers |
| X | 1223G0001X |
Dentist Specialization: General Practice |
27964 | CA | Dental Providers |
| X | 1223G0001X |
Dentist Specialization: General Practice |
30117 | CA | Dental Providers |
| X | 1223G0001X |
Dentist Specialization: General Practice |
51677 | CA | Dental Providers |
| X | 1223P0300X |
Dentist Specialization: Periodontics |
49443 | CA | Dental Providers |
| X | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
19300 | CA | Dental Providers |
| X | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
45580 | CA | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | PARKSIDE DENTAL CARE, LLP | 30 East 60th St, Suite 801, Ny, Ny 10022 |
| Street Address |
1325 TRAVIS BLVD |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94533-4611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306932736 | Kouch Medical LLC | Durable Medical Equipment & Medical Supplies | 1325 Travis Blvd, Ste B, Fairfield, CA 94533-4611 | 2006-10-05 |
| 1043693153 | Alison Woon Lin Lee | Registered Nurse | 1325 Travis Blvd, Suite C, Fairfield, CA 94533-4611 | 2015-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609487347 | Shayondelice Sledge | Case Manager/Care Coordinator | 3001 N. Texas St., #27, Fairfield, CA 94533 | 2020-08-16 |
| 1508401191 | Tiffany Ann Garcia | Social Worker | 1301 Roman Way, Martinez, CA 94533 | 2019-11-07 |
| 1609424175 | Andrew Stephens | Student in an Organized Health Care Education/Training Program | Dgmc, 101 Bodin Cir, Fairfield, CA 94533 | 2019-08-28 |
| 1821645383 | Michelle Marie Hackett | Marriage & Family Therapist | 1745 Enterprise Dr., Bldg. 2, Ste 1a, Fairfield, CA 94533 | 2019-08-20 |
| 1780154369 | Maria Leonila Ramos Corpuz | Behavior Technician | 744 Empire Street Suite 160, Fairfield, CA 94533 | 2018-11-27 |
| 1629575303 | Jeanne Ann Kiernan | Dentist | 690 Airman Dr, Apo, AA 94533 | 2018-04-10 |
| 1629596820 | Max Kardos | Student in an Organized Health Care Education/Training Program | 801 Empire St., Fairfield, CA 94533 | 2017-09-07 |
| 1780119867 | Justin Denhart Dickson | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir Fairfield Ca 94533, David Grant Medical Center, Fpo, AA 94533 | 2017-04-26 |
| 1639613409 | Behrooz Shafiezadeh | Marriage & Family Therapist | Caminar, 601 Madison Street, Suite D, Fairfield, CA 94533 | 2016-12-13 |
| 1427500164 | Tanya Ayers | Counselor | 801 Empire Street, Fairfield, CA 94533 | 2016-10-28 |
| Find all providers in zip 94533 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700297819 | Andrew Lee | Dentist | 2801 Waterman Blvd Ste 290, Fairfield, CA 94534-2972 | 2014-05-12 |
| 1982824397 | Brian Amoroso | Dentist | 1191 Post Road, First Floor, Fairfield, CT 06824-6007 | 2007-04-26 |
| 1295895779 | Edward B Erndt | Dentist | 5180 Winton Rd, Fairfield, OH 45014 | 2006-12-12 |
| 1952469322 | Fairfield Dental Group | Dentist | 193 Fairfield Rd, Fairfield, NJ 07004-2472 | 2006-12-05 |
| 1407881873 | James E. Stich | Dentist | 1377 Oliver Rd, Fairfield, CA 94534-3470 | 2006-07-12 |
| 1487657391 | Frank Casanova | Dentist | 2801 Waterman Blvd, Ste 290, Fairfield, CA 94534-2972 | 2005-05-24 |
| 1780152660 | Yan Kalika Dental Corporation | Dentist | 1955 W Texas St Ste 12, Fairfield, CA 94533-4462 | 2018-11-08 |
| 1699013367 | Joseph Zerella Jr. | Dentist | 1275 Post Rd, Suite 217, Fairfield, CT 06824 | 2013-01-30 |
| 1194063453 | Alexandra Byrne | Dentist | 1275 Post Road, Suite 217, Fairfield, CT 06824 | 2013-01-22 |
| 1215239272 | Raymond Joseph Helinski | Dentist | 1700 Post Rd, Dr. Jack L. Gish & Assoc., Fairfield, CT 06824 | 2010-11-24 |
| Find all providers in FAIRFIELD | ||||
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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.