11040 Bollinger Canyon Rd Ste K, San Ramon, CA 94582
Phone
(925) 648-8588
Listed under
Individual orthodontists
NPI
1063761609
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Orthodontics and Dentofacial Orthopedics (1223X0400X)
License number on NPI record
61237 (CA)
NPI first issued
Aug 29, 2012
NPI record last updated
Jan 31, 2022
NPI 1063761609 is active in the federal NPPES registry (CMS) with Orthodontics and Dentofacial Orthopedics, an ADA-recognized dental specialty, as its primary taxonomy; license 61237 (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. Orthodontists are dentists who completed an accredited orthodontic residency after dental school. General dentists can also offer braces or aligners, but they are not listed here.
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 Orthodontics lists board-certified orthodontists.