NPIMap

Organization Active NPI

Tavallaei, D.M.D., Corporation

  • Pediatric Dentistry
  • El Dorado Hills, CA
National Provider Identifier
1184780587
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
48036 Issued in CA
Legal business name
TAVALLAEI, D.M.D., CORPORATION
Practice address
3840 El Dorado Hills Blvd
Suite 203
El Dorado Hills, CA 95762-4567
Phone
(916) 941-0303
Fax
(916) 983-9012
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Authorized official

Name
Monica Tavallaei, D.M.D.
Title
Pediatric Dentist
Phone
(916) 941-0303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 48036 CA Primary

Addresses

Primary practice location

3840 El Dorado Hills Blvd
Suite 203
El Dorado Hills, CA 95762-4567

Mailing address

3840 El Dorado Hills Blvd
Suite 203
El Dorado Hills, CA 95762-4567
Phone (916) 941-0303

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1184780587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3840 EL DORADO HILLS BLVD",
            "address_2": "SUITE 203",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957624567",
            "telephone_number": "916-941-0303",
            "fax_number": "916-983-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 EL DORADO HILLS BLVD",
            "address_2": "SUITE 203",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957624567",
            "telephone_number": "916-941-0303",
            "fax_number": "916-983-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVALLAEI, D.M.D., CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "TAVALLAEI",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "916-941-0303",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "48036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Make a Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado Hills, CA

Sources for this page

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