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

Last updated

Aug 18, 2016By the provider in NPPES

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 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mahr F Elder, D.D.S., M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Novato, CA
  • NPI 1841301371
  Medicare reassignment NPD Authorized official
• Jaleh Tina Keyhani, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fairfield, CA
  • NPI 1043214448
  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
  NPD (past)
• Alexis Linnebur Kindred, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Novato, CA
  • NPI 1689103228
  NPD (past)
• My Thanh Nguyen, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Stockton, CA
  • NPI 1871083204
  NPD (past)
• Irving Norflin Riley, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Vacaville, CA
  • NPI 1215922760
  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
  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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• Bahama Lynch
• Brady Kenneth Lyons, DMD
• David C Mabrie, MD
• Lily Mac, O.D.
• Jonathan W Maddox, MFT
• Julia Alejandra Magana Munoz
• Diana Harris Mahar, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Pinole, CA
• Providers in Pinole, CA by specialty
• 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.