Dr. Mansour

Primary specialty

DentistTaxonomy code 122300000X

License

58012 Issued in CA

Legal business name

DR. MANSOUR

Doing business as

Aava Dental

Practice address

68487 E Palm Canyon Dr Ste 1
Cathedral Cty, CA 92234-5434

Phone

(760) 770-2776

NPI assigned

Dec 19, 2012

Last updated

Jan 23, 2013By 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

Yahya Mansour

Title

Owner

Phone

(817) 529-8151

Specialties & licenses 1

Addresses

Other names 1

• Aava Dental Doing business as

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1780920702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68487 E PALM CANYON DR STE 1",
            "city": "CATHEDRAL CTY",
            "state": "CA",
            "postal_code": "922345434",
            "telephone_number": "760-770-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68487 E PALM CANYON DR STE 1",
            "city": "CATHEDRAL CTY",
            "state": "CA",
            "postal_code": "922345434",
            "telephone_number": "760-770-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MANSOUR",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "YAHYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-529-8151"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aava Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Cathedral Cty, CA
• Providers in Cathedral Cty, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.