NPIMap

Organization Active NPI

Greenville Rancheria

  • Dentist
  • Red Bluff, CA
National Provider Identifier
1164780573
Registry record updated Oct 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
32161 Issued in CA
Legal business name
GREENVILLE RANCHERIA
Practice address
343 Oak St
Red Bluff, CA 96080-3304
Phone
(530) 528-8600
Fax
(530) 528-8612
NPI assigned
Apr 24, 2012
Last updated
Oct 2, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GREENVILLE RANCHERIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

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

Authorized official

Name
Dr. Omar Dyab, DDSNPI 1235267980
Title
Executive Medical Director
Phone
(530) 528-8600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 32161 CA Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 56174 CA
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 59948 CA

Addresses

Primary practice location

343 Oak St
Red Bluff, CA 96080-3304

Mailing address

PO Box 279
Greenville, CA 95947-0279
Phone (530) 284-7990

National Provider Directory

National Provider Directory
Tax ID family
Greenville Rancheria TR5 organizations share this tax ID, including this one
Part of
Greenville Rancheria TR

Other organizations with this tax ID 4

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

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": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1164780573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "GREENVILLE",
            "state": "CA",
            "postal_code": "959470279",
            "telephone_number": "530-284-7990",
            "fax_number": "530-284-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 OAK ST",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960803304",
            "telephone_number": "530-528-8600",
            "fax_number": "530-528-8612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE RANCHERIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENVILLE RANCHERIA",
        "enumeration_date": "2012-04-24",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A",
        "authorized_official_last_name": "DYAB",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "EXECUTIVE MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "530-528-8600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "32161",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "56174",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59948",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bluff, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; 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.