NPIMap

Organization Active NPI

Tavallaei, D.M.D., Corporation

  • Dentist
  • Granite Bay, CA
National Provider Identifier
1134716939
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TAVALLAEI, D.M.D., CORPORATION
Practice address
4060 Douglas Blvd Ste 110
Granite Bay, CA 95746-5934
Phone
(916) 260-0646
NPI assigned
Dec 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Authorized official

Name
Megan Castillo
Title
Operations Manager
Phone
(916) 781-6550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

4060 Douglas Blvd Ste 110
Granite Bay, CA 95746-5934

Mailing address

2260 E Bidwell St # 313
Folsom, CA 95630-3555

Other names 1

  • Make A Smile Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Make a Smile17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1609113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1134716939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 E BIDWELL ST # 313",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 DOUGLAS BLVD STE 110",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957465934",
            "telephone_number": "916-260-0646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVALLAEI, D.M.D., CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-28",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "916-781-6550"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Make A Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granite Bay, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.