CHILDREN'S DENTAL INITIATIVE NPI 1790900215

NPI Information

  • NPI: 1790900215
  • Provider Name: CHILDREN'S DENTAL INITIATIVE
  • Classification: Clinic/Center - 261QD0000X
  • Specialization: Dental
  • Entity Type: Organization
  • Other Name: THE HEALTH TRUST
  • Address: 645 WOOL CREEK DR
    SAN JOSE, CA
    ZIP 95112
  • Phone: (408) 961-9869

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NPI Details

CHILDREN'S DENTAL INITIATIVE is a dental clinic center in San Jose, CA. CHILDREN'S DENTAL INITIATIVE NPI is 1790900215. The provider is registered as an organization entity type.
The provider Other Name Is The Health Trust.

The provider's business location address is:

645 WOOL CREEK DR
SAN JOSE, CA
ZIP 95112-617
Phone: (408) 961-9869

The provider's authorized official is Ira Holtzman .
The authorized official title is Chief Financial Officer and has the following contact phone number (408) 961-9869.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QD0000XClinic/CenterDentalG91493-01CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G91493-01MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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