Organization
ADVANTA DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEPIDEH RAZAVI D.D.S (DENTIST)
(510) 596-9000
Entity
Organization
Contact information
Practice address
5915 HOLLIS ST STE A, EMERYVILLE, CA 94608-2066
(510) 596-9000
(510) 596-8800
Mailing address
5915 HOLLIS ST STE A, EMERYVILLE, CA 94608-2066
(510) 596-9000
(510) 596-8800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
42496
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42496
DENTAL LICENSE
CA
Enumeration date
11/21/2011
Last updated
11/21/2011
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