Individual provider Active NPI

Saman Ghaemmaghami, DMD

  • General Practice Dentistry
  • San Bernardino, CA
National Provider Identifier
1013432913
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
101529 Issued in CA
Practice address
4016 University Pkwy
San Bernardino, CA 92407-1821
Phone
(909) 880-1600
NPI assigned
Aug 11, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 101529 CA Primary

Addresses

Primary practice location

4016 University Pkwy
San Bernardino, CA 92407-1821

Mailing address

11540 Claridge Dr
Rancho Cucamonga, CA 91730-7244

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
101529CAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Saman Ghaemmaghami DMD a Professional Dental Corporation General Practice CurrentSince Sep 5, 2021 Accepting new patients
Pomona Professional Dental Corp General Practice Current Accepting new patients
S Lee Dental Corporation CurrentSince Sep 5, 2021 Accepting new patients
Sambangi and Rodgers Dental Corporation General Practice Past Accepting new patients

Locations

4016 University Pkwy
San Bernardino, CA 92407
Phone (909) 880-1600

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1013432913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11540 CLARIDGE DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4016 UNIVERSITY PKWY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924071821",
            "telephone_number": "909-880-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAEMMAGHAMI",
        "first_name": "SAMAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-11",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "101529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.