Susan Ezzati, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

35491 Issued in CA

Practice address

881 Fremont Ave Ste B1
Los Altos, CA 94024-5637

Phone

(650) 949-4734

Fax

(650) 949-5710

NPI assigned

Dec 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

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

• Foothill Dental Care

  • Dentist
  • Los Altos, CA
  • NPI 1427177815
  NPD (past) Authorized official

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760548713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881 FREMONT AVE STE B1",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940245637",
            "telephone_number": "650-949-4734",
            "fax_number": "650-949-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 FREMONT AVE STE B1",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940245637",
            "telephone_number": "650-949-4734",
            "fax_number": "650-949-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZZATI",
        "first_name": "SUSAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "35491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Haunschild Evans, LMFT
• Evonne E. David
• Eye Face & Body Surgery Center LLC
• Eye Lite Optometry, Inc.
• Cyrus Ezzati, DDS
• Dennis Bernard Facchino, PH.D.
• Faircare, Inc.
• Family and Group Therapy , a Professional Corporation
• Family Dentistry Marina Manosov DDS Inc
• Susan Fan, AMFT

• Dentist in Los Altos, CA
• Providers in Los Altos, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.