NPIMap

Organization Active NPI

Tavallaei, D.M.D., Corporation

Doing business as Make a Smile

  • Pediatric Dentistry
  • San Ramon, CA
National Provider Identifier
1386159879
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
1700020026 Issued in CA
Legal business name
TAVALLAEI, D.M.D., CORPORATION
Doing business as
Make a Smile
Practice address
9130 Alcosta Blvd Ste a
San Ramon, CA 94583-3847
Phone
(925) 402-4141
Fax
(916) 983-9012
NPI assigned
Dec 6, 2017
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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 1700020026 CA Primary

Addresses

Primary practice location

9130 Alcosta Blvd Ste a
San Ramon, CA 94583-3847

Mailing address

2260 E Bidwell St Ste 310
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

Locations

2260 E Bidwell St
Ste 310
Folsom, CA 95630

9130 Alcosta Blvd
Ste A
San Ramon, CA 94583
Phone (925) 230-9414

111 Deerwood Rd
Ste 130A
San Ramon, CA 94583

NPI Registry JSON

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1386159879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 E BIDWELL ST STE 310",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9130 ALCOSTA BLVD STE A",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945833847",
            "telephone_number": "925-402-4141",
            "fax_number": "916-983-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVALLAEI, D.M.D., CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "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": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "1700020026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Make a Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Ramon, 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.