NPIMap

Organization Active NPI

Soroushian and Taqavi Dental Corporation

  • Dentist
  • Modesto, CA
National Provider Identifier
1588038327
Registry record updated Nov 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOROUSHIAN AND TAQAVI DENTAL CORPORATION
Doing business as
Grace Dental of Modesto
Practice address
3125 Coffee Rd Ste 4
Modesto, CA 95355-1768
Phone
(209) 526-8182
Fax
(209) 526-8214
NPI assigned
Nov 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2015

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

Authorized official

Name
Mr. Pooya Sorooshian
Title
Office Manager
Phone
(925) 876-4680

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

3125 Coffee Rd Ste 4
Modesto, CA 95355-1768

Mailing address

3125 Coffee Rd Ste 4
Modesto, CA 95355-1768
Phone (209) 526-8182

Other names 1

  • Grace Dental of Modesto Doing business as

National Provider Directory

National Provider Directory

Locations

3125 Coffee Rd
Ste 4
Modesto, CA 95355
Phone (209) 526-8182

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447718400000",
    "number": "1588038327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 COFFEE RD STE 4",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551768",
            "telephone_number": "209-526-8182",
            "fax_number": "209-526-8214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 COFFEE RD STE 4",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551768",
            "telephone_number": "209-526-8182",
            "fax_number": "209-526-8214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOROUSHIAN AND TAQAVI DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-17",
        "last_updated": "2015-11-17",
        "status": "A",
        "authorized_official_last_name": "SOROOSHIAN",
        "authorized_official_first_name": "POOYA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "925-876-4680",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Dental of Modesto",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; 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.