Individual provider Active NPI

Mary Louise Shoff, DMD

  • General Practice Dentistry
  • Beverly Hills, CA
National Provider Identifier
1609520931
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
107076 Issued in CA
Practice address
9465 Wilshire Blvd Ste 450
Beverly Hills, CA 90212-2614
Phone
(310) 274-0456
NPI assigned
Feb 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 107076 CA Primary

Addresses

Primary practice location

9465 Wilshire Blvd Ste 450
Beverly Hills, CA 90212-2614

Mailing address

1380 Midvale Ave Apt 314
Los Angeles, CA 90024-6246
Phone (530) 526-0926

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241219000276 CA Practitioner - Dentist 8921535626 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107076CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Harmony Dental Care General Practice Current Accepting new patients
Mission City Community Network, Inc. CurrentSince Oct 11, 2024 Accepting new patients
Mission City Community Network, Inc. Current Accepting new patients
J. Sands, D.D.S. Inc. PastSince Feb 1, 2022 Accepting new patients
Jean-Jacques Elbaz DDS Ms a Prof Dental Corp PastSince Aug 7, 2022 Accepting new patients

Locations

8527 Sepulveda Blvd
North Hills, CA 91343
Phone (310) 926-4865

15206 Parthenia St
Sepulveda, CA 91343

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1644105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1609520931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 MIDVALE AVE APT 314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900246246",
            "telephone_number": "530-526-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9465 WILSHIRE BLVD STE 450",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902122614",
            "telephone_number": "310-274-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOFF",
        "first_name": "MARY",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-06",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

Verify at the official NPI Registry.