Healthcare Provider Details

I. General information

NPI: 1023602885
Provider Name (Legal Business Name): ROYA YAVARI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 SE MILITARY DRIVE B101
SAN ANTONIO TX
78223
US

IV. Provider business mailing address

16915 SONOMA RDG
SAN ANTONIO TX
78255
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-3482
  • Fax: 502-852-1317
Mailing address:
  • Phone: 949-247-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: