Organization
TAVAKOLIAN DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PARDIS TAVAKOLIAN DDS (PRESIDENT)
(240) 750-9239
Entity
Organization
Contact information
Practice address
2041 PIONEER CT STE 100, SAN MATEO, CA 94403-1729
(240) 750-9239
Mailing address
2041 PIONEER CT STE 100, SAN MATEO, CA 94403-1729
(650) 573-0628
(650) 345-2677
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932656949
NPI TYPE 1
CA
Enumeration date
07/30/2022
Last updated
11/20/2022
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