Individual provider Active NPI

Vian G Tarzi

  • Dentist
  • Cedar Park, TX
National Provider Identifier
1902384415
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
35925 Issued in TX
Practice address
115 S Lakeline Blvd Ste 200
Cedar Park, TX 78613-2762
Phone
(512) 640-3360
NPI assigned
Aug 6, 2018
Last updated
May 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 103021 CA
Dentist 122300000X 35925 TX Primary

Addresses

Primary practice location

115 S Lakeline Blvd Ste 200
Cedar Park, TX 78613-2762

Mailing address

19069 Clover CT
Riverside, CA 92508-6282
Phone (919) 758-0181

Other practice location 1

8735 Trautwein Rd
Riverside, CA 92508-9474
Phone (951) 776-1330

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
I20181105001977 CA Order and Referring Only - DentistPractitioner - Dentist 9830442052

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35925TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
TX DDS Alliance - Marbella, LLC CurrentSince May 25, 2021 Accepting new patients
Lynda Watanabe Professional Dental Corporation Past Accepting new patients

Locations

115 S Lakeline Blvd
Ste 200
Cedar Park, TX 78613
Phone (512) 640-3360

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1533513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1902384415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19069 CLOVER CT",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925086282",
            "telephone_number": "919-758-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S LAKELINE BLVD STE 200",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132762",
            "telephone_number": "512-640-3360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8735 Trautwein Rd",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925089474",
            "country_code": "US",
            "telephone_number": "951-776-1330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TARZI",
        "first_name": "VIAN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-06",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "103021",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "35925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Park, TX

Sources for this page

Verify at the official NPI Registry.