Active NPI
Minoo Makassebi, DDS
- General Practice Dentistry
- Vallejo, CA
National Provider Identifier
1508947292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 50315
- Practice address
- 133 Plaza Dr
Vallejo, CA 94591-3703 - Phone
- (707) 557-6245
- Fax
- (707) 557-0968
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 50315 | CA | Primary |
Addresses
Primary practice location
133 Plaza Dr
Vallejo, CA 94591-3703
Mailing address
1626 Pierce St
Apt 16
San Francisco, CA 94115-5224
Phone (415) 238-1680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50315 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508947292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1626 PIERCE ST",
"address_2": "APT 16",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941155224",
"telephone_number": "415-238-1680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 PLAZA DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945913703",
"telephone_number": "707-557-6245",
"fax_number": "707-557-0968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAKASSEBI",
"first_name": "MINOO",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "50315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.