NPIMap

Organization Active NPI

Shahin Mahallati Dental Corp

  • General Practice Dentistry
  • San Clemente, CA
National Provider Identifier
1962043919
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SHAHIN MAHALLATI DENTAL CORP
Practice address
653 Camino de Los Mares Ste 113
San Clemente, CA 92673-2856
Phone
(949) 248-7772
NPI assigned
Oct 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Authorized official

Name
Dr. Shahin Mahallati, DDSNPI 1487931598
Title
Owner
Phone
(949) 248-7772

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

653 Camino de Los Mares Ste 113
San Clemente, CA 92673-2856

Mailing address

653 Camino de Los Mares Ste 113
San Clemente, CA 92673-2856
Phone (949) 248-7772

Other names 1

  • Smile San Clemente Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1569888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1962043919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 CAMINO DE LOS MARES STE 113",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732856",
            "telephone_number": "949-248-7772",
            "fax_number": "949-248-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 CAMINO DE LOS MARES STE 113",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732856",
            "telephone_number": "949-248-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAHIN MAHALLATI DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-01",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "MAHALLATI",
        "authorized_official_first_name": "SHAHIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-248-7772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile San Clemente",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smile San Clemente",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Clemente, CA

Sources for this page

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

Verify at the official NPI Registry.