NPIMap

Organization Active NPI

Shirin Yasrebi, DDS

  • Pediatric Dentistry
  • Lakeland, FL
National Provider Identifier
1427219773
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN12434 Issued in FL
Legal business name
SHIRIN YASREBI, DDS
Practice address
2015 E Edgewood Dr
Lakeland, FL 33803-3601
Phone
(863) 667-9000
Fax
(863) 665-4368
NPI assigned
Jun 19, 2008
Last updated
Jun 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Dr. Shirin Yasrebi, DDSNPI 1821006800
Title
Dentist
Phone
(863) 667-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DN5634 FL
Pediatric Dentistry 1223P0221X DN12434 FL Primary

Addresses

Primary practice location

2015 E Edgewood Dr
Lakeland, FL 33803-3601

Mailing address

2015 E Edgewood Dr
Lakeland, FL 33803-3601
Phone (863) 667-9000

Other identifiers 1

IdentifierTypeStateIssuer
073762300MedicaidFL

National Provider Directory

National Provider Directory

Locations

2015 E Edgewood Dr
Lakeland, FL 33803
Phone (863) 667-9000

Practitioners & affiliated clinicians

Practitioners 1

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": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1427219773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 E EDGEWOOD DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338033601",
            "telephone_number": "863-667-9000",
            "fax_number": "863-665-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 E EDGEWOOD DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338033601",
            "telephone_number": "863-667-9000",
            "fax_number": "863-665-4368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIRIN YASREBI, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "YASREBI",
        "authorized_official_first_name": "SHIRIN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "863-667-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN5634",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN12434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "073762300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.