Alireza Sadre-Nassiri, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

109541 Issued in CA

Practice address

925 Bevins CT
Lakeport, CA 95453-9754

Phone

(707) 263-8382

Fax

(707) 263-5326

NPI assigned

Jun 28, 2012

Last updated

Aug 1, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alinassiri@mai.allscriptsdirect.net
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Lake County Tribal Health Consortium Inc.

  • Federally Qualified Health Center (FQHC)
  • Lakeport, CA
  • NPI 1881697381
  Medicare reassignment NPD
• Ali Nassiri DMD and Xiaoying Deng DDS

  dba Alpine Pediatric Dentistry

  • Pediatric Dentistry
  • Kirkland, WA
  • NPI 1497501274
  NPD Authorized official
• Ali Nassiri PLLC

  dba Rainier Pediatric Dentistry

  • Pediatric Dentistry
  • Lakewood, WA
  • NPI 1801455381
  NPD Authorized official
• Lake County Tribal Health Southshore Clinic

  • Federally Qualified Health Center (FQHC)
  • Clearlake, CA
  • NPI 1063158038
  NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD

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

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1740544303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1950",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954531950",
            "telephone_number": "707-263-8382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 BEVINS CT",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954539754",
            "telephone_number": "707-263-8382",
            "fax_number": "707-263-5326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6003 100th St SW",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "WA",
            "postal_code": "984992733",
            "country_code": "US",
            "telephone_number": "425-466-0595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14440 Olympic Dr",
            "address_purpose": "LOCATION",
            "city": "Clearlake",
            "state": "CA",
            "postal_code": "954228809",
            "country_code": "US",
            "telephone_number": "707-263-8382",
            "fax_number": "707-461-5102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SADRE-NASSIRI",
        "first_name": "ALIREZA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-28",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "056780",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "60737991",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "056780",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "109541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1223G0001X",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bernard Roseman, RX
• Nicolaus Gus Rosete, NP
• Diane Sigrid Rowe, PHARMD
• Johanna Ruiz, RN, PHN, MSN
• Sacred Life Recovery Services
• Safeway Inc (Safeway Pharmacy #0983)
• Michelle Sagehorn, REHAB SPECIALIST
• Shayaan Sajid
• Messina Salazar
• Jessica Salmeron

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; 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.