NPIMap

Organization Active NPI

The Safoura Massouri Professional Dental Corp

Doing business as Childrens Primary Dental Care & Adult Dental Group

  • Pediatric Dentistry
  • Chula Vista, CA
National Provider Identifier
1306988118
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
40677 Issued in CA
Legal business name
THE SAFOURA MASSOURI PROFESSIONAL DENTAL CORP
Doing business as
Childrens Primary Dental Care & Adult Dental Group
Practice address
397 E St
Ste #a
Chula Vista, CA 91910
Phone
(619) 425-9930
Fax
(619) 425-9887
NPI assigned
Feb 12, 2007
Last updated
May 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

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

Authorized official

Name
Safoura Massoumi, D.D.S.NPI 1497823561
Title
Owner
Phone
(619) 425-9930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 40677 CA Primary

Addresses

Primary practice location

397 E St
Ste #a
Chula Vista, CA 91910

Mailing address

397 E St
Ste #a
Chula Vista, CA 91910
Phone (619) 425-9930

Other identifiers 1

IdentifierTypeStateIssuer
G9226501MedicaidCA

Other names 1

  • Childrens Primary Dental Care & Adult Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Children's Primary Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

397 E St
Ste A
Chula Vista, CA 91910
Phone (619) 425-9930

Practitioners & affiliated clinicians

Practitioners 4

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": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1306988118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 E ST",
            "address_2": "STE #A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-425-9930",
            "fax_number": "619-425-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 E ST",
            "address_2": "STE #A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-425-9930",
            "fax_number": "619-425-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SAFOURA MASSOURI PROFESSIONAL DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "MASSOUMI",
        "authorized_official_first_name": "SAFOURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-425-9930",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "40677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9226501",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Childrens Primary Dental Care & Adult Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; 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.