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  7. NPI Record 1710289947

DESIGNER DENTISTRY GROUP OF RIALTO
Complete NPI Record 1710289947
Dentist - Orthodontics and Dentofacial Orthopedics in Rialto, CA

NPI Status: Active since November 19, 2010

Contact Information

1786 N RIVERSIDE AVE
SUITE 5
RIALTO, CA
ZIP 92376
Phone: (909) 874-0323
Fax: (909) 874-2984

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Provider License Number 1
  29. Provider License Number State Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Healthcare Provider Taxonomy Code 2
  32. Provider License Number 2
  33. Provider License Number State Code 2
  34. Healthcare Provider Primary Taxonomy Switch 2
  35. Healthcare Provider Taxonomy Code 3
  36. Provider License Number 3
  37. Provider License Number State Code 3
  38. Healthcare Provider Primary Taxonomy Switch 3
  39. Healthcare Provider Taxonomy Code 4
  40. Provider License Number 4
  41. Provider License Number State Code 4
  42. Healthcare Provider Primary Taxonomy Switch 4
  43. Healthcare Provider Taxonomy Code 5
  44. Provider License Number 5
  45. Provider License Number State Code 5
  46. Healthcare Provider Primary Taxonomy Switch 5
  47. Healthcare Provider Taxonomy Code 6
  48. Provider License Number 6
  49. Provider License Number State Code 6
  50. Healthcare Provider Primary Taxonomy Switch 6
  51. Healthcare Provider Taxonomy Code 7
  52. Provider License Number 7
  53. Provider License Number State Code 7
  54. Healthcare Provider Primary Taxonomy Switch 7
  55. Healthcare Provider Taxonomy Code 8
  56. Provider License Number 8
  57. Provider License Number State Code 8
  58. Healthcare Provider Primary Taxonomy Switch 8
  59. Healthcare Provider Taxonomy Code 9
  60. Provider License Number 9
  61. Provider License Number State Code 9
  62. Healthcare Provider Primary Taxonomy Switch 9
  63. Healthcare Provider Taxonomy Code 10
  64. Provider License Number 10
  65. Provider License Number State Code 10
  66. Healthcare Provider Primary Taxonomy Switch 10
  67. Is Organization Subpart
  68. Authorized Official Name Prefix Text
  69. Healthcare Provider Taxonomy Group 1
  70. Healthcare Provider Taxonomy Group 2
  71. Healthcare Provider Taxonomy Group 3
  72. Healthcare Provider Taxonomy Group 4
  73. Healthcare Provider Taxonomy Group 5
  74. Healthcare Provider Taxonomy Group 6
  75. Healthcare Provider Taxonomy Group 7
  76. Healthcare Provider Taxonomy Group 8
  77. Healthcare Provider Taxonomy Group 9
  78. Healthcare Provider Taxonomy Group 10

Complete NPI Dataset

This page represents the complete record for NPI 1710289947. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1710289947
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 1786 N RIVERSIDE AVE
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 5
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: RIALTO
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 923768059
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 9098740323
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 9098742984
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1786 N RIVERSIDE AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 5
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: RIALTO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 923768059
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9098740323
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 9098742984
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 11/19/2010
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/19/2010
The date that a record was last updated or changed.
Authorized Official Last Name: DELARA
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: RAFAELA
The first name of the authorized official.
Authorized Official Title or Position: ADMINISTRATOR
The title or position of the authorized official.
Authorized Official Telephone Number: 9098740323
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 1223G0001X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 57581
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 1223G0001X
Provider License Number 2: 57930
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 1223G0001X
Provider License Number 3: 46985
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 1223G0001X
Provider License Number 4: 59318
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 1223G0001X
Provider License Number 5: 58057
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 1223G0001X
Provider License Number 6: 53832
Provider License Number State Code 6: CA
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 1223P0300X
Provider License Number 7: 38226
Provider License Number State Code 7: CA
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 1223S0112X
Provider License Number 8: 24358
Provider License Number State Code 8: CA
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 124Q00000X
Provider License Number 9: 25296
Provider License Number State Code 9: CA
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 1223X0400X
Provider License Number 10: 48644
Provider License Number State Code 10: CA
Healthcare Provider Primary Taxonomy Switch 10: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MRS.
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193400000X MULTIPLE SINGLE SPECIALTY GROUP