Healthcare Provider Details

I. General information

NPI: 1346166089
Provider Name (Legal Business Name): PAUL M KASROVI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 DAVIS RD STE 1
ORINDA CA
94563-3028
US

IV. Provider business mailing address

96 DAVIS RD STE 1
ORINDA CA
94563-3028
US

V. Phone/Fax

Practice location:
  • Phone: 925-253-4900
  • Fax:
Mailing address:
  • Phone: 925-253-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA WIETH
Title or Position: DIRECTOR OF PAYER RELATIONS
Credential:
Phone: 623-267-8121