M Elder D D S a Professional Corporation

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

46586 Issued in CA

Legal business name

M ELDER D D S A PROFESSIONAL CORPORATION

Practice address

2150 Appian Way Ste 201
Pinole Oral Surgery
Pinole, CA 94564-2520

Phone

(510) 724-3922

Fax

(510) 724-1037

NPI assigned

Oct 1, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Mahr Fairuke Elder, DDS, MDNPI 1841301371

Title

President / Ceo

Phone

(415) 892-1190

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Pinole Oral Surgery2 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.

• Pinole Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Pinole, CA
  • NPI 1710118708
  NPD tax ID

Locations

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mahr F Elder, D.D.S., M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Novato, CA
  • NPI 1841301371

  CA, Oral and Maxillofacial Surgery

  Medicare reassignment NPD Authorized official
• Jaleh Tina Keyhani, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fairfield, CA
  • NPI 1043214448

  CA

  Medicare reassignment
• Willard Osibin III, DDS

  • Student in an Organized Health Care Education/Training Program
  • Bronx, NY
  • NPI 1205178357

  CA

  Medicare reassignment
• Robert Gerard Allen, D.D.S.

  • Oral and Maxillofacial Pathology Dentistry
  • Petaluma, CA
  • NPI 1356425979
  NPD (past)
• Santokh Bhullar, MD

  • Internal Medicine Physician
  • Manteca, CA
  • NPI 1760594105
  NPD (past)
• Jeffery Robert Graves, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Vallejo, CA
  • NPI 1184601791

  Oral and Maxillofacial Surgery

  NPD (past)
• Michael R Knoll, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Alameda, CA
  • NPI 1669691200

  Oral and Maxillofacial Surgery

  NPD (past)
• My Thanh Nguyen, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Stockton, CA
  • NPI 1871083204

  Oral and Maxillofacial Surgery

  NPD (past)
• Irving Norflin Riley, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Vacaville, CA
  • NPI 1215922760

  Oral and Maxillofacial Surgery

  NPD (past)
• Susan Katherine Snyder, D.M.D., M.D.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Palo Alto, CA
  • NPI 1134412307
  NPD (past)
• Randall Wayne Stettler, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • La Mesa, CA
  • NPI 1124244686

  Oral and Maxillofacial Surgery

  NPD (past)
• Ho Hyun Brian Sun, DMD, MS

  • Oral and Maxillofacial Surgery (Dentist)
  • San Jose, CA
  • NPI 1407372154

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471478400000",
    "number": "1760633341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 ADMIRAL CALLAGHAN LANE STE B",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "94591",
            "telephone_number": "415-892-1190",
            "fax_number": "415-892-7355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 APPIAN WAY STE 201",
            "address_2": "PINOLE ORAL SURGERY",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642520",
            "telephone_number": "510-724-3922",
            "fax_number": "510-724-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M ELDER D D S A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-01",
        "last_updated": "2016-08-18",
        "status": "A",
        "authorized_official_last_name": "ELDER",
        "authorized_official_first_name": "MAHR",
        "authorized_official_middle_name": "FAIRUKE",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "415-892-1190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "46586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lily Mac, O.D.
• Jonathan W Maddox, MFT
• Julia Alejandra Magana Munoz
• Diana Harris Mahar, M.D.

• All providers in Pinole, CA
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.