Active NPI
Lynnette Shugan, DMD
- General Practice Dentistry
- Chula Vista, CA
National Provider Identifier
1932508942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8445
- Practice address
- 397 E St Ste a
Chula Vista, CA 91910-2684 - Phone
- (619) 425-9930
- NPI assigned
- Aug 14, 2014
- Last updated
- Mar 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8445 | SC | Primary |
Addresses
Primary practice location
397 E St Ste a
Chula Vista, CA 91910-2684
Mailing address
6035 Rivers Ave Ste a
North Charleston, SC 29406-5018
Phone (843) 572-9909
Other practice location 1
6035 Rivers Ave Ste A
North Charleston, SC 29406-5018
Phone (843) 572-9909
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
| License | State | Type | Specialty |
|---|---|---|---|
| 8445 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Safoura Massouri Professional Dental Corp | Past | Accepting new patients | |
| Safoura Massoumi Professional Dental Corp. | Past | Accepting new patients |
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.
-
dba Children's Primary Dental Group
- Pediatric Dentistry
- Chula Vista, CA
- NPI 1356471460
-
dba Childrens Primary Dental Care & Adult Dental Group
- Pediatric Dentistry
- Chula Vista, CA
- NPI 1306988118
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615334400000",
"number": "1932508942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6035 RIVERS AVE STE A",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294065018",
"telephone_number": "843-572-9909",
"fax_number": "843-572-9901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "397 E ST STE A",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919102684",
"telephone_number": "619-425-9930"
}
],
"practiceLocations": [
{
"address_1": "6035 Rivers Ave Ste A",
"address_purpose": "LOCATION",
"city": "North Charleston",
"state": "SC",
"postal_code": "294065018",
"country_code": "US",
"telephone_number": "843-572-9909",
"fax_number": "843-572-9901",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHUGAN",
"first_name": "LYNNETTE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-14",
"last_updated": "2021-03-10",
"certification_date": "2021-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "8445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.