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General NPI Number Information
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NPI Number | 1144436494
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Entity Type | Organization
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Legal Business Name | P M KASROVI DDS MS A PROF DENTAL CORP
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 910 ENSENADA AVE
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City | BERKELEY
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State | CA
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Zip | 94705
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Country | US
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Telephone | 510-204-8856
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 COLBY ST #220
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City | BERKELEY
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State | CA
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Zip | 94705
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Country | US
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Telephone | 510-204-8856
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL M KASROVI
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Credential | DDS MS
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Telephone | 510-204-8856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 40362
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License Number State | CA
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