Selina Mahesri, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

107189 Issued in CA

Practice address

1041 E Yorba Linda Blvd
Placentia, CA 92870-3728

Phone

(714) 528-8252

NPI assigned

May 4, 2020

Last updated

Nov 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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

State licenses

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

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1578184255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15076 AVENIDA DE LAS FLORES",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095014",
            "telephone_number": "510-305-6240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 E YORBA LINDA BLVD",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928703728",
            "telephone_number": "714-528-8252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Brookdale Plz",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112123139",
            "country_code": "US",
            "telephone_number": "718-240-6281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHESRI",
        "first_name": "SELINA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-04",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "107189",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelica Macedonio
• Michelle An Mach, M.P.T.
• Valerie Magallon
• Julian S Mahecha Gutierrez
• Aries Rene Maher
• Duy Mai, RPH
• Makar Makarian
• Christine Makimoto-Williams
• Marissa Melia Maldonado
• Deeti Mali

• Pediatric Dentistry in Placentia, CA
• Providers in Placentia, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.