TAVALLAEI DMD CORP (NPI# 1467877894) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467877894 |
| Entity Type | Organization |
| Organization Name | TAVALLAEI DMD CORP |
| Other Organization Name | MAKE A SMILE CHILDREN'S DENTAL |
| Practice Address |
2260 E Bidwell St Suite 305 Folsom CA 95630-3463 |
| Mailing Address |
2241 Sunset Blvd Suite D Rocklin CA 95765-4295 |
| Practice Telephone | 9163800102 |
| Mailing Telephone | 9163800102 |
| Mailing Fax Number | 9169839012 |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2014-02-21 |
| Authorized Official Name | DR. MONICA TAVALLAEI (OWNER) |
| Authorized Official Telephone | 9167816550 |
| Authorized Official Credential | D.M.D |
| 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 |
|---|---|---|---|---|
| 1417399502 | Tavallaei Dmd Corp | Dentist | 731 Sterling Pkwy, Suite 100, Lincoln, CA 95648-7306 | 2013-07-18 |
| Street Address |
2260 E BIDWELL ST SUITE 305 |
| City | FOLSOM |
| State | CA |
| Zip Code | 95630-3463 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578724928 | M. Tavallaei, Dmd,inc. | Dentist | 2260 E Bidwell St, Suite 110, Folsom, CA 95630-3463 | 2008-06-18 |
| 1205226875 | S. Jang Dds Incorporated | Dentist | 2260 E Bidwell St, # 110, Folsom, CA 95630-3463 | 2015-02-03 |
| 1861729600 | Gary Morrid Ellison | Chiropractor | 2260 E Bidwell St, Ste. 108, Folsom, CA 95630-3554 | 2009-11-16 |
| 1730311424 | Bradley Robert Falke | Chiropractor | 2260 E Bidwell St, Ste 108, Folsom, CA 95630-3554 | 2009-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831724657 | Corrections and Rehabilitation | Pharmacy | 570 E. Natoma Street, Folsom, CA 95630 | 2020-03-12 |
| 1174153027 | Haley Harmon | Nurse Practitioner | 1621 Creekside Dr. Creekside Ob/gyn, Ste. 102, Folsom, CA 95630 | 2020-01-20 |
| 1932741469 | Ruma Ramani Jolly | Speech-Language Pathologist | 250 Mc Adoo Drive, Willow Springs, Apt.911, Folsom, CA 95630 | 2019-10-16 |
| 1750844767 | Sharon Munyaanyi | Registered Nurse | 1600 Creekside Dr Ste 3700, Folsom, CA 95630 | 2019-04-08 |
| 1104308345 | Stephanie Whatley | Optometrist | 2390 E Bidwell St Ste 400, Folsom, CA 95630 | 2018-09-04 |
| 1447746607 | Heather Michellee Thrapp | Behavioral Analyst | 125 Oak Ravine Way, Folsom, CA 95630 | 2018-07-10 |
| 1700370483 | Loretta May Delgado | Behavior Technician | 322 Crow Cany, Folsom, CA 95630 | 2018-06-18 |
| 1417448176 | Sound Support Inc. | Hearing Instrument Specialist | 610 East Bidwell Street, Suite A, Folsom, CA 95630 | 2018-05-29 |
| 1548750144 | Don Peterson Md, Sugical Assisting | General Practice | Mercy Hospital of Folsom (dignity Health Folsom), 1650 Creekside Dr., Folsom, CA 95630 | 2018-05-18 |
| 1245733328 | American Heritage Hospice Inc | Hospice Care, Community Based | 1837 Iron Point Rd Ste 180, Folsom, CA 95630 | 2018-03-14 |
| Find all providers in zip 95630 | ||||
| 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 |
|---|---|---|---|---|
| 1538225503 | Tavallaei, D.m.d., Corporation | Dentist | 2190 E. Bidwell St., Folsom, CA 95630 | 2006-12-28 |
| 1700969706 | Jennifer Lee Ryan | Dentist | 2545 E Bidwell St Ste 100, Folsom, CA 95630-6443 | 2006-10-23 |
| 1801883756 | Blake Edwin Moore | Dentist | 2190 E Bidwell St, Folsom, CA 95630-6453 | 2005-10-05 |
| 1699244244 | Rohini Rattu Dds, Inc. | Dentist | 1665 Creekside Dr Ste 103, Folsom, CA 95630-3538 | 2018-11-13 |
| 1194115154 | S.y. Jang Dds Corporatiom | Dentist | 2190 E Bidwell St, Folsom, CA 95630-6453 | 2015-01-29 |
| 1912290412 | Charles Chi Hao Leung | Dentist | 2190 E Bidwell St, Folsom, CA 95630-6453 | 2011-05-17 |
| 1154577492 | Rohini Taneja Rattu | Dentist | 1665 Creekside Dr Ste 103, Folsom, CA 95630-3538 | 2008-08-18 |
| 1134385636 | A. Paul Reeves, Dmd, Professional Dental Corporation | Dentist | 2545 E Bidwell St, Suite 100, Folsom, CA 95630-6440 | 2008-08-04 |
| 1356558159 | Monica Tavallaei | Dentist | 2190 E Bidwell St, Folsom, CA 95630-6469 | 2007-05-17 |
| 1144437948 | Christopher David Kanas | Dentist | 1568 Creekside Dr Ste 201, Folsom, CA 95630-3449 | 2007-05-17 |
| Find all providers in FOLSOM | ||||
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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.