Reza Mazhari, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11225 Issued in MN

Practice address

708 County Road B W
Roseville, MN 55113-4527

Phone

(651) 489-0161

Fax

(651) 489-9938

NPI assigned

Jul 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Roseville Family Dental Care, P.a.

  • General Practice Dentistry
  • Roseville, MN
  • NPI 1770503096
  NPD (past)

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952321259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 COUNTY ROAD B W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134527",
            "telephone_number": "651-489-0161",
            "fax_number": "651-489-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 COUNTY ROAD B W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134527",
            "telephone_number": "651-489-0161",
            "fax_number": "651-489-9938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZHARI",
        "first_name": "REZA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melvy S Mathew
• Zachary Mattson, PA-C
• Scott Charles Mauch, M.D.
• Maxillofacial Imaging LLC (Advanced Head & Neck Imaging)
• Benjamin John May, M.D.
• Logan McAbee-Thomas, LICSW
• Jennifer June McCarthy, PHARM. D
• Jennifer Suzanne McCarthy, MSN, APRN, CNP
• Susan I McClelland, LPN
• Andrea McCormick

• General Practice Dentistry in Roseville, MN
• Providers in Roseville, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.