TAVALLAEI DMD CORP (NPI# 1417399502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417399502 |
| Entity Type | Organization |
| Organization Name | TAVALLAEI DMD CORP |
| Other Organization Name | MAKE A SMILE CHILDREN'S DENTAL |
| Practice Address |
731 Sterling Pkwy Suite 100 Lincoln CA 95648-7306 |
| Mailing Address |
2260 E Bidwell St Suite 310 Folsom CA 95630-3463 |
| Practice Telephone | 9162587639 |
| Practice Fax Number | 9169839012 |
| Mailing Telephone | 9162587639 |
| Mailing Fax Number | 9169839012 |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2014-04-09 |
| Authorized Official Name | DR. MONICA TAVALLAEI (OWNER) |
| Authorized Official Telephone | 9162587639 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
48036 | CA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Make A Smile Children's Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467877894 | Tavallaei Dmd Corp | Dentist | 2260 E Bidwell St, Suite 305, Folsom, CA 95630-3463 | 2014-02-21 |
| Street Address |
731 STERLING PKWY SUITE 100 |
| City | LINCOLN |
| State | CA |
| Zip Code | 95648-7306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841681913 | S. Jang Dds Incorporated | Dentist | 731 Sterling Pkwy, Suite # 100, Lincoln, CA 95648-7306 | 2015-02-11 |
| 1386034080 | S.y. Jang Dds Corporatiom | Dentist | 731 Sterling Pkwy, # 100, Lincoln, CA 95648-7306 | 2015-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770125460 | Mary Anne Leavell | Technician | 2010 Hwy. 193, Lincoln, CA 95648 | 2019-10-14 |
| 1184144487 | Nicolas Sean Losenicky | Non-emergency Medical Transport (VAN) | 818 Equinox Loop, Lincoln, CA 95648 | 2017-06-27 |
| 1437587946 | Sakura Moua | Pharmacist | 950 Groveland Lane, Target Pharmacy, Lincoln, CA 95648 | 2013-10-18 |
| 1154698132 | Donald R Myers | Pharmacist | 405 South Highway 65, Lincoln, CA 95648 | 2011-11-19 |
| 1568757110 | Bryan Lee | Dentist | 1510 Del Webb Blvd Ste B106, Lincoln, CA 95648 | 2011-06-11 |
| 1881901437 | Irene Bailon Hermo | Dentist | 831 Sterling Parkway Suite 130, Lincoln, CA 95648 | 2010-09-02 |
| 1851424501 | Maria Eloisa B Espiritu | Dentist | 2295 Fieldstone Drive, Suite 240, Lincoln, CA 95648 | 2007-03-13 |
| 1184752966 | Eireann Elizabeth Smith | Marriage & Family Therapist | 110 Gateway Oaks Drive, Suite 210, Lincoln, CA 95648 | 2007-03-01 |
| 1407982697 | Lincoln Internal Medicine, A Medical Corp. | Internal Medicine | 801 Sterling Parkway #120, Suite D, Lincoln, CA 95648 | 2007-02-24 |
| 1073656518 | Paul Ernest Denzler | Dentist | 588 First St., Lincoln, CA 95648 | 2007-02-15 |
| Find all providers in zip 95648 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992295612 | S.y.y Jang Dds Corp | Dentist | 731 Sterling Pkwy Ste 100c, Lincoln, CA 95648-7307 | 2018-05-17 |
| 1669976684 | M. Kucera, Dds, Inc. | Dentist | 150 Gateway Dr Ste 101, Lincoln, CA 95648-3316 | 2018-03-23 |
| 1083135545 | Roy S Burkhalter IIi | Dentist | 4000 East Campus Loop, Lincoln, NE 68583-0740 | 2017-07-05 |
| 1386984441 | Gregory Fought Dds PC | Dentist | 8600 Executive Woods Dr, Suite 100, Lincoln, NE 68512-9301 | 2013-02-26 |
| 1407105299 | Lincoln Pediatric Dentistry | Dentist | 4301 S 80th St, Suite A, Lincoln, NE 68516-4404 | 2012-09-07 |
| 1568504272 | Cynthia M Chan | Dentist | 3131 O St, Lincoln, NE 68510-1534 | 2007-02-12 |
| 1457400681 | South Lincoln Pediatric Dentistry LLC | Dentist | 6030 Village Dr, Suite 100, Lincoln, NE 68516 | 2007-01-09 |
| 1427113240 | Mary Virginia Osenbaugh | Dentist | 4630 Antelope Creek Rd, Suite 140, Lincoln, NE 68506-5592 | 2006-12-22 |
| 1003975640 | Tom J Milius | Dentist | 2621 S 70th St, Ste A, Lincoln, NE 68506-2911 | 2006-12-08 |
| 1104913581 | Kristin K Kohler | Dentist | 1660 S 70th St, Suite 200, Lincoln, NE 68506-1570 | 2006-10-06 |
| Find all providers in LINCOLN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.