| Mark Tavakoli Dds Dental Corp | |
|
485 34th St Ste 102 Oakland CA 94609-2823 | |
| (925) 285-2125 | |
| Not Available |
| Full Name | Mark Tavakoli Dds Dental Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 485 34th St Ste 102, Oakland, California |
| Authorized Official Name and Position | Mark Majid Tavakoli (CEO) |
| Authorized Official Contact | 9252852125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Tavakoli Dds Dental Corp 2210 Loch Ln Walnut Creek CA 94598-3369 Ph: (925) 285-2125 | Mark Tavakoli Dds Dental Corp 485 34th St Ste 102 Oakland CA 94609-2823 Ph: (925) 285-2125 |
| NPI Number | 1528715570 |
|---|---|
| Provider Enumeration Date | 03/09/2022 |
| Last Update Date | 03/24/2023 |
| Medicare PECOS PAC ID | 2668859455 |
|---|---|
| Medicare Enrollment ID | O20220517001325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528715570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Mark Majid Tavakoli |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1013482868 PECOS PAC ID: 3577940360 Enrollment ID: I20220518000715 |
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