Meridian Dental Associates

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MERIDIAN DENTAL ASSOCIATES

Doing business as

Willow Glen Dental Center

Practice address

1241 Meridian Avenue
San Jose, CA 95125

Phone

(408) 266-6144

Fax

(408) 676-4443

NPI assigned

May 16, 2017

Last updated

May 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Raoul R Shah, DDSNPI 1104904531

Title

Owner

Phone

(408) 266-6144

Specialties & licenses 8

Addresses

Other names 1

• Willow Glen Dental Center Doing business as

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.

• Raoul Rashmi Shah, DDS

  • General Practice Dentistry
  • San Jose, CA
  • NPI 1104904531
  Authorized official Same address or phone

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

{
    "created_epoch": "1494892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1982131306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 MERIDIAN AVENUE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95125",
            "telephone_number": "408-266-6144",
            "fax_number": "408-676-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 MERIDIAN AVENUE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95125",
            "telephone_number": "408-266-6144",
            "fax_number": "408-676-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-16",
        "last_updated": "2024-05-09",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "RAOUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-266-6144",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Glen Dental Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Glen Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexandra Sierra Meriales
• Lander Merida Gonzales
• Meridian Acupuncture
• Meridian Acupuncture
• Meridian Acupuncture and Herb
• Meridian Medical Group Professional Corp
• Meridian Treatment Acupuncture Corp
• Maria Merino
• Max Kai Merrill-Hypko
• Poupak Merrill, PH.D.

• General Practice Dentistry in San Jose, CA
• Providers in San Jose, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.