| Advanta Dental Group | |
|
5915 Hollis St Ste A Emeryville CA 94608-2066 | |
| (510) 596-9000 | |
| (510) 596-8800 |
| Full Name | Advanta Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 5915 Hollis St Ste A, Emeryville, California |
| Authorized Official Name and Position | Sepideh Razavi (DENTIST) |
| Authorized Official Contact | 5105969000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanta Dental Group 5915 Hollis St Ste A Emeryville CA 94608-2066 Ph: (510) 596-9000 | Advanta Dental Group 5915 Hollis St Ste A Emeryville CA 94608-2066 Ph: (510) 596-9000 |
| NPI Number | 1104193051 |
|---|---|
| Provider Enumeration Date | 11/21/2011 |
| Last Update Date | 11/21/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104193051 | NPI | - | NPPES |
| 42496 | Other | CA | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 42496 (California) | Primary |
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