Ava Manoochehri, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109221 Issued in CA

Practice address

370 Coddingtown Ctr
Santa Rosa, CA 95401-3507

Phone

(707) 867-1310

NPI assigned

Nov 6, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bautista and Patel Dental

  • General Practice Dentistry
  • Santa Rosa, CA
  • NPI 1053982439
  NPD

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

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1548033905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 WILD ROSE PL",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926567058",
            "telephone_number": "949-338-6015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 CODDINGTOWN CTR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954013507",
            "telephone_number": "707-867-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANOOCHEHRI",
        "first_name": "AVA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sneha Sowrabha Bangra Manjeshwar
• Kelsey Manley
• Stephanie Manley
• Carla Marie Manly, PH.D.
• Deborah Mannle
• Pamela C. Mansfield, LCSW
• Dennis Manthe
• Lisa Ann Manthe, MFT, A.T.R. - BC
• Deanna Manzano
• Edgar Ivan Manzano

• General Practice Dentistry in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.