1720 E Los Angeles Ave Ste 224, Simi Valley, CA 93065
Phone
(805) 581-0144
Listed under
Oral & maxillofacial surgeons
NPI
1104322288
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Oral and Maxillofacial Surgery (1223S0112X)
Credentials listed
DDS
License number on NPI record
102258 (CA)
NPI first issued
Apr 5, 2018
NPI record last updated
Jul 6, 2021
NPI 1104322288 is active in the federal NPPES registry (CMS) with Oral and Maxillofacial Surgery, an ADA-recognized dental specialty, as its primary taxonomy; license 102258 (CA) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Oral and maxillofacial surgeons are trained in surgery of the mouth and jaws, including placing implants, extractions, bone grafts and sinus lifts, and in anesthesia. Dentists who are not specialists can also place implants; the specialty here is the one the provider registered as primary.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Prosthodontics, the American Board of Oral and Maxillofacial Surgery and the American Board of Periodontology each list their board-certified members.