# ADVANTA DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104193051
- **Authorized official:** DR. SEPIDEH RAZAVI D.D.S (DENTIST)
- **Authorized official phone:** (510) 596-9000

## Contact information

- **Practice address:** 5915 HOLLIS ST STE A, EMERYVILLE, CA 94608-2066
- **Practice address phone:** (510) 596-9000
- **Practice address fax:** (510) 596-8800
- **Mailing address:** 5915 HOLLIS ST STE A, EMERYVILLE, CA 94608-2066
- **Mailing address phone:** (510) 596-9000
- **Mailing address fax:** (510) 596-8800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 42496 | CA | Yes |

## Other

- **Enumeration date:** 11/21/2011
- **Last updated:** 11/21/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 42496 | DENTAL LICENSE | CA |