Siadatie a Prof Dental Corp

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SIADATIE A PROF DENTAL CORP

Doing business as

accessible dental center

Practice address

3873 Stockdale Hwy
Bakersfield, CA 93309-2189

Phone

(805) 377-2222

Fax

(805) 377-2222

NPI assigned

Sep 15, 2017

Organization subpart

No

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

Authorized official

Name

Tisa Siadatie, DDSNPI 1407026909

Title

Managing Dentist

Phone

(661) 412-7747

Specialties & licenses 1

Addresses

Other names 1

• accessible dental center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tisa Siadatie, D.D.S.

  • Dentist
  • Bakersfield, CA
  • NPI 1407026909
  NPD Authorized official

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613347200000",
    "number": "1568981017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3873 STOCKDALE HWY",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933092189",
            "telephone_number": "661-412-7747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3873 STOCKDALE HWY",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933092189",
            "telephone_number": "805-377-2222",
            "fax_number": "805-377-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIADATIE A PROF DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A",
        "authorized_official_last_name": "SIADATIE",
        "authorized_official_first_name": "TISA",
        "authorized_official_title_or_position": "MANAGING DENTIST",
        "authorized_official_telephone_number": "661-412-7747",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "accessible dental center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James D Shuler, MD
• Barbara Shumaker, LCSW
• Jeremy Emanuel Shumaker Jr.
• Zainab Dalia Shurbaji, THERAPIST
• Latisha Genise Shyne-Dixon, LVN
• Tisa Siadatie, D.D.S.
• Rukia Sial
• Siamak Karimian,MD.Prof.Corp
• Ed Marie Sibal-Gomez, M.D.
• Genesis Leilani Sibal, RN

• Dental Clinic/Center in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; 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.