Individual provider Active NPI

Nader A Nadershahi, DDS

  • General Practice Dentistry
  • San Anselmo, CA
National Provider Identifier
1871784918
Registry record updated Aug 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
42191 Issued in CA
Practice address
122 Tunstead Ave
San Anselmo, CA 94960-2622
Phone
(415) 459-0114
Fax
(415) 459-2717
NPI assigned
Aug 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2007

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 42191 CA Primary

Addresses

Primary practice location

122 Tunstead Ave
San Anselmo, CA 94960-2622

Mailing address

122 Tunstead Ave
San Anselmo, CA 94960-2622
Phone (415) 459-0114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
42191CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186272000000",
    "number": "1871784918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 TUNSTEAD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602622",
            "telephone_number": "415-459-0114",
            "fax_number": "415-459-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 TUNSTEAD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602622",
            "telephone_number": "415-459-0114",
            "fax_number": "415-459-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NADERSHAHI",
        "first_name": "NADER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-05",
        "last_updated": "2007-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Anselmo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2007; 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.