JAVAD SAGE AGHALOO, D.D.S. — NPI 1073708582 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in EL CENTRO, CA)

CMS-1500 Box 24J / 33a • NPI

1073708582

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1223G0001X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

1502 S. LA BRUCHERIE RD., EL CENTRO, CA, 92243

Official NPPES Practice Location

Practice Phone & Referral Fax

(760) 482-5505

Fax: (760) 482-5501

⚠️ HHS OIG LEIE FEDERAL EXCLUSION ALERT: NPI 1073708582 matches an active entry in the HHS Office of Inspector General List of Excluded Individuals/Entities (Sec. 1128(a)(1) — Conviction of Program-Related Crimes (Mandatory 5-Yr Min) — Effective 2024-10-20). Verify before submitting Medicare/Medicaid claims.

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1073708582` (NPI-1 Individual Practitioner)
Provider / Legal Name	JAVAD SAGE AGHALOO, D.D.S.
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223G0001X` (Dentist, General Practice)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	1502 S. LA BRUCHERIE RD., EL CENTRO, CA, 92243
Practice Telephone / Fax	Tel: (760) 482-5505 \| Fax: (760) 482-5501
Administrative Mailing Address	1502 S. LA BRUCHERIE RD., EL CENTRO, CA, 92243
Enumeration & Last Sync	Enumerated: 2007-09-07 \| CMS Record Updated: 2015-05-05

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1502 S. LA BRUCHERIE RD., EL CENTRO, CA, 92243

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Plain-English Taxonomy & CMS Crosswalk (1223G0001X)

What Does Taxonomy Code 1223G0001X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223G0001X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JAVAD SAGE AGHALOO, D.D.S.)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`122300000X` — Dentist Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: CA \| License: `51184` \| Primary: Secondary
`1223G0001X` — Dentist, General Practice Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: CA \| License: `51184` \| Primary: Yes (Primary)

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JAVAD SAGE AGHALOO, D.D.S. (NPI #1073708582)