Healthcare Provider Details

I. General information

NPI: 1629296991
Provider Name (Legal Business Name): DANIEL AFSHIN MOBATI MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 DANA ST SUITE 202
BERKELEY CA
94704-2895
US

IV. Provider business mailing address

5500 LA SALLE AVENUE
OAKLAND CA
94611
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1055
  • Fax: 510-848-9100
Mailing address:
  • Phone: 415-902-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number41286
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA85226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: