Active NPI
Jackson Reza Moezi, D.D.S.
- Dentist
- Vacaville, CA
National Provider Identifier
1073636445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 37707
- Practice address
- 3000 Alamo Dr
Suite 107
Vacaville, CA 95687-6350 - Phone
- (707) 446-7701
- Fax
- (707) 446-1628
- NPI assigned
- Apr 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 37707 | CA | Primary |
Addresses
Primary practice location
3000 Alamo Dr
Suite 107
Vacaville, CA 95687-6350
Mailing address
1350 Burton Dr
Ste 230
Vacaville, CA 95687-3542
Phone (707) 446-7701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160907000300 | CA | Order and Referring Only - Dentist | 7012203722 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37707 | CA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470182400000",
"number": "1073636445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 BURTON DR",
"address_2": "STE 230",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956873542",
"telephone_number": "707-446-7701",
"fax_number": "707-446-1628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 ALAMO DR",
"address_2": "SUITE 107",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956876350",
"telephone_number": "707-446-7701",
"fax_number": "707-446-1628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOEZI",
"first_name": "JACKSON",
"middle_name": "REZA",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2016-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "37707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.