Healthcare Provider Details

I. General information

NPI: 1710927165
Provider Name (Legal Business Name): JAVID YAVARI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3294 MEDLOCK BRIDGE RD
NORCROSS GA
30092-3082
US

IV. Provider business mailing address

2706 ABBEY CT.
ALPHARETTA GA
30092-3082
US

V. Phone/Fax

Practice location:
  • Phone: 770-448-8882
  • Fax: 770-446-5511
Mailing address:
  • Phone: 770-664-1999
  • Fax: 770-664-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN011424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: