NPIMap

Organization Active NPI

Tavallaei DMD Corp

Doing business as Make a Smile

  • Dental Clinic/Center
  • Stockton, CA
National Provider Identifier
1407690811
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
TAVALLAEI DMD CORP
Doing business as
Make a Smile
Practice address
5756 Pacific Ave Ste 75a
Stockton, CA 95207-5156
Phone
(916) 984-0304
NPI assigned
Jun 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Authorized official

Name
Megan Castillo
Title
Admin
Phone
(916) 781-6550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

5756 Pacific Ave Ste 75a
Stockton, CA 95207-5156

Mailing address

400 Plaza Dr # 120-319
Folsom, CA 95630-4744

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

5756 Pacific Ave
Ste 75A
Stockton, CA 95207
Phone (916) 984-0304

NPI Registry JSON

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

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1407690811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 PLAZA DR # 120-319",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956304744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5756 PACIFIC AVE STE 75A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075156",
            "telephone_number": "916-984-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVALLAEI DMD CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "916-781-6550"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Make a Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.