Ez Smile Family Dental Group

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

60893 Issued in CA

Legal business name

EZ SMILE FAMILY DENTAL GROUP

Practice address

4757 Hoen Ave
Santa Rosa, CA 95405-7862

Phone

(707) 575-9595

Fax

(707) 575-5122

NPI assigned

Nov 17, 2015

Organization subpart

No

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

Authorized official

Name

Payam Behradnia, D.D.S.

Title

President

Phone

(707) 575-9595

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Ez Smile Family Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Payam Behradnia Dmo, a Dental Corp

  • Dentist
  • Santa Rosa, CA
  • NPI 1316332000
  NPD tax ID

Locations

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": "1669846416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4757 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057862",
            "telephone_number": "707-575-9595",
            "fax_number": "707-575-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4757 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057862",
            "telephone_number": "707-575-9595",
            "fax_number": "707-575-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EZ SMILE FAMILY DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-17",
        "last_updated": "2015-11-17",
        "status": "A",
        "authorized_official_last_name": "BEHRADNIA",
        "authorized_official_first_name": "PAYAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-575-9595",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "60893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL",
            "identifier": "1194038059",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eye Care Institute, a Medical Corporation
• Eye Care Institute, a Medical Corporation
• Eye Care Institute, a Medical Corporation
• Eye Care Institute, a Medical Corporation
• Gary J Eyre, DC
• Face to Face, Sonoma County AIDS Network
• Mark R. Fahey, MD
• Gloria Rita Fahy, PT
• Jennifer Rae Fairbairn, CMT
• Leah Marie Fairbank, AMFT

• Health Maintenance Organization in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Health Maintenance Organization in California

• 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.