Active NPI
Makan Vafadar, D.D.S.
- General Practice Dentistry
- Glendale, CA
National Provider Identifier
1720130859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 47201
- Practice address
- 1300 S Central Ave
Glendale, CA 91204-2506 - Phone
- (818) 245-8410
- Fax
- (310) 571-3300
- NPI assigned
- Jan 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 47201 | CA | Primary |
Addresses
Primary practice location
1300 S Central Ave
Glendale, CA 91204-2506
Mailing address
1300 S Central Ave
Glendale, CA 91204-2506
Phone (818) 245-8410
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B47201-01 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47201 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337644800000",
"number": "1720130859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 S CENTRAL AVE",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912042506",
"telephone_number": "818-245-8410",
"fax_number": "818-245-8412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 S CENTRAL AVE",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912042506",
"telephone_number": "818-245-8410",
"fax_number": "310-571-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAFADAR",
"first_name": "MAKAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2012-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "47201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B47201-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.