NPIMap

Individual provider Active NPI

Haitham Shasha

  • Dentist
  • La Mesa, CA
National Provider Identifier
1124474911
Registry record updated Aug 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
100206 Issued in CA
Practice address
8419 La Mesa Blvd Ste a
La Mesa, CA 91942-5381
Phone
(619) 464-3191
NPI assigned
May 11, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 100206 CA Primary

Addresses

Primary practice location

8419 La Mesa Blvd Ste a
La Mesa, CA 91942-5381

Mailing address

8419 La Mesa Blvd Ste a
La Mesa, CA 91942-5381
Phone (619) 464-3191

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

Practice roles

OrganizationSpecialtyStatusNew patients
Samer R. Namoo DDS, Inc CurrentSince Sep 3, 2025 Accepting new patients
Petros Toma & Putrus Dental Corp Dentist Past Accepting new patients
Petros.Toma&Putrus Dental Corp Past Accepting new patients

Locations

8419 La Mesa Blvd
Ste A
La Mesa, CA 91942
Phone (619) 464-3191

Organizations & group practices 3

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": "1462924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756512000000",
    "number": "1124474911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8419 LA MESA BLVD STE A",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425381",
            "telephone_number": "619-464-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8419 LA MESA BLVD STE A",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425381",
            "telephone_number": "619-464-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHASHA",
        "first_name": "HAITHAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-11",
        "last_updated": "2025-08-30",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "100206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2025; 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.