NPIMap

Organization Active NPI

Khazali Dental Corporation

Doing business as Main Street Dental Group

  • General Practice Dentistry
  • Ventura, CA
National Provider Identifier
1073698429
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KHAZALI DENTAL CORPORATION
Doing business as
Main Street Dental Group
Practice address
4360-C E Main St
Ventura, CA 93003
Phone
(805) 644-6110
Fax
(805) 644-6160
NPI assigned
Oct 26, 2006
Last updated
Feb 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Authorized official

Name
Dr. Maral Khazali, DDS
Title
Owner DDS
Phone
(805) 644-6110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4360-C E Main St
Ventura, CA 93003

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 508-3600

Other names 1

  • MAIN STREET DENTAL GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

4360 E Main St
Ste C
Ventura, CA 93003
Phone (805) 426-4739

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1073698429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-508-3600",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4360-C E MAIN ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "93003",
            "telephone_number": "805-644-6110",
            "fax_number": "805-644-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAZALI DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "KHAZALI",
        "authorized_official_first_name": "MARAL",
        "authorized_official_title_or_position": "OWNER DDS",
        "authorized_official_telephone_number": "805-644-6110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MAIN STREET DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ventura, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; 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.