TAVALLAEI, D.M.D., CORPORATION (NPI# 1508349606) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508349606 |
| Entity Type | Organization |
| Organization Name | TAVALLAEI, D.M.D., CORPORATION |
| Other Organization Name | MAKE A SMILE DENTAL |
| Practice Address |
6406 Sunrise Blvd Ste A Citrus Heights CA 95610-5992 |
| Mailing Address |
2260 E Bidwell St Folsom CA 95630-3555 |
| Practice Telephone | 9163060333 |
| Mailing Telephone | 9167816550 |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2018-09-13 |
| Authorized Official Name | MEGAN CASTILLO (OPERATIONS MANAGER) |
| Authorized Official Telephone | 9167816550 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Make A Smile Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740795657 | Tavallaei, D.m.d., Corporation | Dentist | 1955 W Texas St Ste 2a, Fairfield, CA 94533-4462 | 2017-12-14 |
| 1386159879 | Tavallaei, D.m.d., Corporation | Dentist | 111 Deerwood Rd Ste 130a, San Ramon, CA 94583-4409 | 2017-12-06 |
| 1922261882 | Tavallaei, D.m.d., Corporation | Dentist | 9585 Laguna Springs Dr, Suite 120, Elk Grove, CA 95758-7969 | 2008-07-09 |
| 1538225933 | Tavallaei, D.m.d., Corporation | Dentist | 500 Auburn Folsom Rd, Suite330, Auburn, CA 95603 | 2006-12-29 |
| 1538225503 | Tavallaei, D.m.d., Corporation | Dentist | 2190 E. Bidwell St., Folsom, CA 95630 | 2006-12-28 |
| 1194107748 | Tavallaei, D.m.d., Corporation | Dentist | 7227 29th St, Sacramento, CA 95822-5005 | 2015-06-19 |
| 1992008098 | Tavallaei, D.m.d., Corporation | Dentist | 3433 Arden Way, Sacramento, CA 95825-2018 | 2010-12-10 |
| 1871752915 | Tavallaei, D.m.d., Corporation | Dentist | 2241 Sunset Blvd, Suite D, Rocklin, CA 95765-4295 | 2008-06-04 |
| 1184780587 | Tavallaei, D.m.d., Corporation | Dentist | 3840 El Dorado Hills Blvd, Suite 203, El Dorado Hills, CA 95762-4567 | 2006-12-29 |
| Street Address |
6406 SUNRISE BLVD STE A |
| City | CITRUS HEIGHTS |
| State | CA |
| Zip Code | 95610-5992 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326682113 | Gregory Dilts | Behavior Technician | 5620 Birdcage Street, 230, Citrus Heights, CA 95610 | 2019-11-04 |
| 1831684059 | Omara Sin | Behavior Technician | 5620 Birdcage Street, Suite 230, Citrus Heights, CA 95610 | 2018-06-29 |
| 1528427804 | Mpl Group, LLC | General Practice | 7601 Sunrise Blvd., Suite 8, Citrus Heights, CA 95610 | 2016-02-16 |
| 1851788327 | L.kravchuk Dental Corporation | Dentist | 6240 San Juan Ave, Suite#f, Citrus Heights, CA 95610 | 2015-04-22 |
| 1093152035 | Lynda Louise Dickerson | Marriage & Family Therapist | 5750 Sunrise Blvd., Citrus Heights, CA 95610 | 2013-05-31 |
| 1346582640 | Vista Child Therapy LLC | Physical Therapist | 7579 Old Auburn Road, Citrus Heights, CA 95610 | 2013-03-25 |
| 1982954475 | Exam Collections and Testing Services LLC | Health Maintenance Organization | 6060 Sunrise Vista Dr Ste 1975, Citrus Heights, CA 95610 | 2012-09-12 |
| 1235486168 | Adam Olives | Behavioral Analyst | 5750 Sunrise Blvd Ste 210b, Citrus Heights, CA 95610 | 2012-08-09 |
| 1245598598 | William S. Fastiggi | Veterinarian | 7484 Sunrise Blvd, Citrus Heights, CA 95610 | 2012-04-24 |
| 1295023679 | The Living Water | Residential Treatment Facility, Physical Disabilities | 7504 Chipmunk Way, Citrus Heights, CA 95610 | 2011-07-19 |
| Find all providers in zip 95610 | ||||
| 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 |
|---|---|---|---|---|
| 1710973227 | Jennifer Fox Mccarthy | Dentist | 7916 Pebble Beach Dr Ste 101, Citrus Heights, CA 95610-7790 | 2005-09-21 |
| 1578555629 | Cynthia L Weideman | Dentist | 7916 Pebble Beach Dr, Suite 101, Citrus Heights, CA 95610-7790 | 2005-08-16 |
| 1386982114 | Jeffrey V Sue | Dentist | 7916 Pebble Beach Dr Ste 101, Citrus Heights, CA 95610-7790 | 2013-01-29 |
| 1467572412 | Darcy Lynn Owen | Dentist | 7916 Pebble Beach Dr, Suite 101, Citrus Heights, CA 95610-7790 | 2007-03-30 |
| 1578575023 | Weideman Professional Dental Corporation | Dentist | 7916 Pebble Beach Dr, Suite 101, Citrus Heights, CA 95610-7790 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385227 | Johnson Ann Wong Dental Corporation | Dentist | 6512 N Figueroa St Ste 3, Los Angeles, CA 90042-2155 | 2020-10-26 |
| 1205440211 | Jessica Choi, Dmd, Dental Corporation | Dentist | 2318 Huntington Dr, San Marino, CA 91108-2641 | 2020-09-08 |
| 1659985802 | Rw Fattouch Dmd, Inc. | Dentist | 42210 Lyndie Ln Ste 100, Temecula, CA 92591-3604 | 2020-09-04 |
| 1174136998 | Armand Begian Dds Inc. | Dentist | 4021 Mission Oaks Blvd # 180, Camarillo, CA 93012-5156 | 2020-08-31 |
| 1164035473 | Armand Begian Dds Inc. | Dentist | 3687 Las Posas Rd Ste 180, Camarillo, CA 93010-1431 | 2020-08-26 |
| 1518577972 | Michael Vincent Laureola Dds Inc | Dentist | 2862 Unit A Canyon Springs Parkway, Riverside, CA 92507 | 2020-07-31 |
| 1396360384 | Drs Salem and Soliman Dental Corp | Dentist | 2119 E Hatch Rd Ste Bandc, Modesto, CA 95351-4814 | 2020-06-15 |
| 1689299471 | Abhishek Batra | Dentist | 11052 Evans St, Loma Linda, CA 92354-2709 | 2020-06-08 |
| 1194348060 | Bryan Chao | Dentist | 1895 Mowry Ave Ste 121, Fremont, CA 94538-1736 | 2020-05-26 |
| 1255953618 | Mohammad Abul-fielat Dds Inc | Dentist | 3825 Tyler St, Riverside, CA 92503 | 2020-05-08 |
| Find all providers with the same taxonomy | ||||
| City | CITRUS HEIGHTS |
| Zip Code | 95610 |
Please comment or provide details below to improve the information on TAVALLAEI, D.M.D., CORPORATION.
| 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.