Active NPI
Eveette Michelle Tavakkoly, RDH
- Dental Hygienist
- San Clemente, CA
National Provider Identifier
1972709897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 21667
- Practice address
- 647 Camino de Los Mares Ste 209
San Clemente, CA 92673-2807 - Phone
- (949) 493-9311
- NPI assigned
- Jun 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 21667 | CA | Primary |
Addresses
Primary practice location
647 Camino de Los Mares Ste 209
San Clemente, CA 92673-2807
Mailing address
23701 Arjay Way
Laguna Niguel, CA 92677-4642
Phone (949) 425-1120
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 |
|---|---|---|---|
| 21667 | CA | MD | Registered Respiratory Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jon Marashi, DDS, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- San Clemente, CA
- NPI 1639382427
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972709897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23701 ARJAY WAY",
"city": "LAGUNA NIGUEL",
"state": "CA",
"postal_code": "926774642",
"telephone_number": "949-425-1120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "647 CAMINO DE LOS MARES STE 209",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926732807",
"telephone_number": "949-493-9311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVAKKOLY",
"first_name": "EVEETTE",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "21667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.