NPIMap

Organization Active NPI

Tavallaei DMD Corp

Doing business as Make A Smile Children's Dental

  • Pediatric Dentistry
  • Folsom, CA
National Provider Identifier
1467877894
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
48036 Issued in CA
Legal business name
TAVALLAEI DMD CORP
Doing business as
Make A Smile Children's Dental
Practice address
2260 E Bidwell St
Suite 305
Folsom, CA 95630-3463
Phone
(916) 380-0102
NPI assigned
Feb 21, 2014
Last updated
Aug 10, 2022By the provider in NPPES
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
Dr. Monica Tavallaei, D.M.D
Title
Owner
Phone
(916) 781-6550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 48036 CA Primary

Addresses

Primary practice location

2260 E Bidwell St
Suite 305
Folsom, CA 95630-3463

Mailing address

2241 Sunset Blvd
Suite D
Rocklin, CA 95765-4295
Phone (916) 380-0102

Other names 1

  • Make A Smile Children's Dental 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 305
Folsom, CA 95630
Phone (916) 380-0102

NPI Registry JSON

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

{
    "created_epoch": "1392940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1467877894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2241 SUNSET BLVD",
            "address_2": "SUITE D",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957654295",
            "telephone_number": "916-380-0102",
            "fax_number": "916-983-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 E BIDWELL ST",
            "address_2": "SUITE 305",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303463",
            "telephone_number": "916-380-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVALLAEI DMD CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-21",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "TAVALLAEI",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-781-6550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "48036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Make A Smile Children's Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Folsom, 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.