NPIMap

Organization Active NPI

Keith Tam DDS Professional Corp

Doing business as Santa Maria Pediatric Dental Group

  • Dentist
  • Santa Maria, CA
National Provider Identifier
1922541481
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
57293 Issued in CA
Legal business name
KEITH TAM DDS PROFESSIONAL CORP
Doing business as
Santa Maria Pediatric Dental Group
Practice address
570 E Betteravia Rd
Ste C
Santa Maria, CA 93454-8805
Phone
(805) 922-2888
Fax
(805) 925-0888
NPI assigned
Nov 30, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Dr. Keith Tam, DDSNPI 1710141783
Title
Owner
Phone
(949) 322-9778

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 57293 CA Primary

Addresses

Primary practice location

570 E Betteravia Rd
Ste C
Santa Maria, CA 93454-8805

Mailing address

570 E Betteravia Rd
Ste C
Santa Maria, CA 93454-8805
Phone (805) 922-2888

Other names 1

  • Santa Maria Pediatric Dental Group Doing business as

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1922541481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 E BETTERAVIA RD",
            "address_2": "STE C",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934548805",
            "telephone_number": "805-922-2888",
            "fax_number": "805-925-0888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 E BETTERAVIA RD",
            "address_2": "STE C",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934548805",
            "telephone_number": "805-922-2888",
            "fax_number": "805-925-0888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH TAM DDS PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "TAM",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-322-9778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "57293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Maria Pediatric Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Maria, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.