NPIMap

Organization Active NPI

Tavallaei, D.M.D., Corporation

Doing business as Make a Smile

  • Pediatric Dentistry
  • Rocklin, CA
National Provider Identifier
1871752915
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
48036 Issued in CA
Legal business name
TAVALLAEI, D.M.D., CORPORATION
Doing business as
Make a Smile
Practice address
2241 Sunset Blvd
Suite D
Rocklin, CA 95765-4295
Phone
(916) 380-0102
Fax
(916) 983-9012
NPI assigned
Jun 4, 2008
Last updated
Apr 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

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

Authorized official

Name
Dr. Monica Tavallaei, DMD
Title
Pediatric Dentist
Phone
(916) 380-0102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 48036 CA Primary

Addresses

Primary practice location

2241 Sunset Blvd
Suite D
Rocklin, CA 95765-4295

Mailing address

2241 Sunset Blvd
Suite D
Rocklin, CA 95765-4295
Phone (916) 380-0102

Other names 1

  • Make a Smile Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Make a Smile17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

2241 Sunset Blvd
Ste D
Rocklin, CA 95765
Phone (916) 380-0102

NPI Registry JSON

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

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460419200000",
    "number": "1871752915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2241 SUNSET BLVD",
            "address_2": "SUITE D",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957654295",
            "telephone_number": "916-380-0102",
            "fax_number": "916-983-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2241 SUNSET BLVD",
            "address_2": "SUITE D",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957654295",
            "telephone_number": "916-380-0102",
            "fax_number": "916-983-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVALLAEI, D.M.D., CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-04",
        "last_updated": "2016-04-12",
        "status": "A",
        "authorized_official_last_name": "TAVALLAEI",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "916-380-0102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "48036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Make a Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocklin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; 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.