Healthcare Provider Details

I. General information

NPI: 1972444115
Provider Name (Legal Business Name): MARK TAVAKOLI DDS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 EDGEWATER DR STE 1
OAKLAND CA
94621-2019
US

IV. Provider business mailing address

8105 EDGEWATER DR STE 1
OAKLAND CA
94621-2019
US

V. Phone/Fax

Practice location:
  • Phone: 510-256-7116
  • Fax: 510-344-7311
Mailing address:
  • Phone: 510-256-7116
  • Fax: 510-344-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK MAJID TAVAKOLI
Title or Position: CEO
Credential: DDS., MS
Phone: 925-285-2125