Individual provider Active NPI

Ayesha Sajjad, DDS

  • General Practice Dentistry
  • Modesto, CA
National Provider Identifier
1811582331
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
106048 Issued in CA
Practice address
2045 W Briggsmore Ave
Modesto, CA 95350-3767
Phone
(209) 241-5510
NPI assigned
Mar 5, 2021
Last updated
Mar 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 106048 CA Primary

Addresses

Primary practice location

2045 W Briggsmore Ave
Modesto, CA 95350-3767

Mailing address

2045 W Briggsmore Ave
Modesto, CA 95350-3767

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240528000057 CA Order and Referring Only - DentistPractitioner - Dentist 0345682092

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
106048CAMDMarriage & Family Therapist

Interoperability endpoints

  • Direct secure messaging: ayesha.sajjad.1@17661.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1811582331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 W BRIGGSMORE AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 W BRIGGSMORE AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503767",
            "telephone_number": "209-241-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAJJAD",
        "first_name": "AYESHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "106048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.