NPIMap

Organization Active NPI

Mussie Sibhatu DDS, a Dental Corporation

  • Dentist
  • Oakland, CA
National Provider Identifier
1114671997
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MUSSIE SIBHATU DDS, A DENTAL CORPORATION
Practice address
3630 Macarthur Blvd
Oakland, CA 94619-1328
Phone
(510) 530-3317
Fax
(510) 530-3370
NPI assigned
Feb 9, 2022
Organization subpart
Yes
Parent organization
MUSSIE SIBHATU DDSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
Dr. Mussie Sibhatu, DDS, MSNPI 1376755942
Title
Dentist Owner
Phone
(510) 520-1533

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

3630 Macarthur Blvd
Oakland, CA 94619-1328

Mailing address

3147 Telegraph Ave
Oakland, CA 94609-3206
Phone (510) 420-1717

Other identifiers 1

IdentifierTypeStateIssuer
D1288907OtherCADENTAL INSURANCE

Other names 2

  • Laurel Smile Dentistry Doing business as
  • Oakland Smile Dentistry Doing business as

National Provider Directory

National Provider Directory
Part of
Mussie Sibhatu DDS Inc

Locations

3147 Telegraph Ave
Oakland, CA 94609
Phone (425) 577-2651

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1114671997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3147 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093206",
            "telephone_number": "510-420-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 MACARTHUR BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946191328",
            "telephone_number": "510-530-3317",
            "fax_number": "510-530-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSSIE SIBHATU DDS, A DENTAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUSSIE SIBHATU DDS",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "SIBHATU",
        "authorized_official_first_name": "MUSSIE",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "510-520-1533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL INSURANCE",
            "identifier": "D1288907",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Smile Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oakland Smile Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.