NPIMap

Organization Active NPI

Tavallaei, D.M.D., Corporation

  • Pediatric Dentistry
  • Sacramento, CA
National Provider Identifier
1194107748
Registry record updated Mar 1, 2023
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
7227 29TH St Ste a
Sacramento, CA 95822-5005
Phone
(916) 984-0304
Fax
(916) 983-9012
NPI assigned
Jun 19, 2015
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 48036 CA Primary

Addresses

Primary practice location

7227 29TH St Ste a
Sacramento, CA 95822-5005

Mailing address

2260 E Bidwell St
#309
Folsom, CA 95630-3463
Phone (916) 984-0304

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

Locations

2260 E Bidwell St
#309
Folsom, CA 95630

7227 29th St
Ste A
Sacramento, CA 95822
Phone (916) 984-0304

NPI Registry JSON

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

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1194107748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 E BIDWELL ST",
            "address_2": "#309",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303463",
            "telephone_number": "916-984-0304",
            "fax_number": "916-983-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7227 29TH ST STE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958225005",
            "telephone_number": "916-984-0304",
            "fax_number": "916-983-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVALLAEI, D.M.D., CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-19",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "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": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "48036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.